No midwife due to new rules

[Bluegoat]

I'm so upset, I have just started TTC, and went looking for midwives. With the new rules in place in my province, Nova Scotia, there is no way I can get one for a home birth in my town. They are all now employees of the health districts. I am so upset and don't know what to do.

[ChaoticMum]

I hear you loud and clear. We are in Manitoba - I had to deliver in hospital with my first as the midwives are not private. I then delvered my next two in AB with private midwives at home.

I am now back in Manitoba and pregnant with #4 - I can't even GET a midwife. They are booked solid and I'm 3rd on a waiting list, so I have to either go UC - which I would never take the risk of personally, or go with a GP in town til 28wks then go to the OB in the city - which is what we're doing.

The midwives are very good at trying their best to give you the same care in the hospital - granted it ISN'T at home, but there is a huge difference between OB's and midwives most times, so hopefully you'll still have a good experience!

s: I keep telling myself that the main goal of everything is to have a healthy baby no matter where that child arrives. Safe and sound for both baby and I are what matters and that is what will get me through!

HUGS!

[joyfulgrrrl]

I'm in Manitoba too, and the midwives here give you priority if you want a HB - I'm sorry your province doesn't have a similar policy, that sucks

Tamika, try phoning every week or so, sometimes they need a gentle reminder you're waiting!

And don't forget to have a doula - to me, my doula made 1000% difference in my birth experience.

[dogmom327]

Can you UC? Honestly I think I would UC before I'd go to a hospital.

[BeagleMommy]

I'm in the states, but I know here there are unlicensed "black market" midwives. What about a retired midwife who might be willing to see you? Or a well trained apprentice? That would be better than UC if you don't want to UC, IMO.

[Say]

A friend of mine had a homebirth in Halifax three years ago. I don't know what the rules are, but there ARE midwives out there who will deliver at home for women who want it. There have been midwives working quietly in all provinces. I would perhaps post to the Nova Scotia Tribe looking for help, and keep asking around where you live. If you have time and are resourceful, I think you can find a midwife for a homebirth.

[Bluegoat]

The regulated midwives can do home births as well as hospital births, but it can only be in their own health region. Eventually there will be midwives in all the regions, but no funding yet. My region is in the middle of building a new hospital and won't fund midwife positions until it is done, and then only if they can get funding. Legislation is great but it needs funding.

Theoretically, I could get a private midwife, but NS has been midwife poor. All but one is becoming a health region employee; the other is retiring because the new regulations make it impossible for her to practice.

UC isn't really an option, I have had 2 previous sections and no vaginal births. My husband would be terrified too, which is no good.

I think I am going to contact the retiring midwife, and see what her plans are. If she is not interested, I'll get a good doula and labour at home till the end. I am at a different hospital now with a much lower section rate, and I am 2 min away instead of an hour, so I guess it's doable.

hanks for all your replies, I am feeling much more calm now.

[pjs]

I guess as a women who hopes to have more homebirths in the US, it is scary to me to learn that universal health coverage "options" are so limited that one couldn't have a midwife unless you book an appt before you're even pregnant. Though I think something needs to happen to health care costs, I hope this isn't the direction the US takes.

[Bluegoat]

Originally Posted by pjs

I guess as a women who hopes to have more homebirths in the US, it is scary to me to learn that universal health coverage "options" are so limited that one couldn't have a midwife unless you book an appt before you're even pregnant. Though I think something needs to happen to health care costs, I hope this isn't the direction the US takes.

To be fair, this is largely a matter of growing pains. Because we haven't had midwifery covered here before, there have been few midwives, and no school for midwives. I would say in five years the situation should be better, especially once they realize that costs for homebirth are less. But it is a very frustrating period now.

[Say]

I guess as a women who hopes to have more homebirths in the US, it is scary to me to learn that universal health coverage "options" are so limited that one couldn't have a midwife unless you book an appt before you're even pregnant. Though I think something needs to happen to health care costs, I hope this isn't the direction the US takes.

The shortage has little to do with universal health care options and more to do with the fact that the transition to fully funded midwifery is recent (within the last ten years) in virtually every province. At the moment - especially because midwives are becoming more popular as woman learn about their birthing options - the demand outweighs the supply. It's frustrating, but there are also areas of the US where even private midwives cannot meet the demand. Also, Canada ranks much better than the US when it comes to infant and maternal mortality rates and is far more progressive about offering women childbirth choices. It may not be a perfect system, but it's a good one.

[DahliaRW]

Originally Posted by pjs

I guess as a women who hopes to have more homebirths in the US, it is scary to me to learn that universal health coverage "options" are so limited that one couldn't have a midwife unless you book an appt before you're even pregnant. Though I think something needs to happen to health care costs, I hope this isn't the direction the US takes.

Well, France which also has universal healthcare has a huge shortage of hb midwives (they have a really hard time getting mws who are "allowed" to attend homebirths). So the problem really isn't limited to Canada. So I would say that is one aspect of UHC that really concerns me.

[joyfulgrrrl]

Originally Posted by DahliaRW

Well, France which also has universal healthcare has a huge shortage of hb midwives (they have a really hard time getting mws who are "allowed" to attend homebirths). So the problem really isn't limited to Canada. So I would say that is one aspect of UHC that really concerns me.

Honestly I don't know what UHC has to do with it - a shortage of midwives is a shortage of midwives, regardless of the funding source. I suppose UHC means that everyone is drawing from the same pool of midwives and you can't queue-jump. But I kind of like that, it's fair to me that I have the same chance of accessing midwifery services as my neighbour. Hopefully as more midwives are trained and certified, more women can take advantage of their services.

And I love knowing that I don't have to worry about whether my insurance company will decline to pay for my HB at the last minute, or refuse to pay the bill for some reason, or stiff my midwife after promising to pay.

[mandib50]

in alberta, midwives have been fully booked for years, and that was without funding, so universal health care has nothing to do with the lack of midwives. the issues are more related to education. there are so few programs in canada and they are relatively difficult to get into, so i don't think the issue of lack of midwives is going away anytime soon.

[Bluegoat]

One thing that is likely related to regulation, is that once midwives are regulated then there are education requirements to practice and requirements to carry insurance. It is hard to see a way around this though, and I wouldn't want any midwife to practice without insurance.

[pjs]

Where I live our hb midwives are not insured. I guess for me I feel more comfortable having a birth at home with an uninsured midwife than having a hospital birth with an insured midwife. It think it says a lot about those in other countries being more community oriented (putting the needs of the community ahead of their own) than we are here in the US. I can't imagine any of my hb friends willingly settling for a hospital birth in the name of fairness- so their neighbor has just as much an equal chance for getting a slot with a midwife as they do. I feel like for the most part here in the US, self-interest trumps all, so it's hard to envision people waiting to see a doc because knee surgery isn't as pressing as a by-pass, but maybe that is changing as our economy melts down and people start to remember that people, not things, are more important.

What is the issue with insurance? Here in the US it is outrageously expensive, but I would think with a nationalized hc system that that wouldn't necessarily be the case?

[Say]

Originally Posted by joyfulgrrrl

Honestly I don't know what UHC has to do with it - a shortage of midwives is a shortage of midwives, regardless of the funding source. I suppose UHC means that everyone is drawing from the same pool of midwives and you can't queue-jump. But I kind of like that, it's fair to me that I have the same chance of accessing midwifery services as my neighbour. Hopefully as more midwives are trained and certified, more women can take advantage of their services.

And I love knowing that I don't have to worry about whether my insurance company will decline to pay for my HB at the last minute, or refuse to pay the bill for some reason, or stiff my midwife after promising to pay.

Yes, thank you!

I don't understand why this topic thread is being used as a springboard for comments on the cons of UCH. If a woman in Canada becomes pregnant, she can choose her own doctor, the hospital she wants to deliver at or choose a midwife and a birthing centre or her home. All prenatal care, including office visits, ultrasounds and lab tests are covered, covered, covered, without a hassle from her insurance company or a discussion with an HMO about 'which' doctors she can see. Period. But just like the States, her number one choice for an OB might be booked up or her local birthing centre might be booked up for the month she is due.

Midwifery funding and support is on the rise in virtually every province in Canada. It is considered to be cost efficient. It is considered to be of vital importance in norther regions that lack OBs (and that's the fault of geography, not UHC). Women are becoming better educated on childbirth options these days, so it's only natural that more and more are choosing midwives, pushing up the demand.

I apologize for going off-topic, but like most Canadians, I'm sensitive to the way our health care system was vilified during the American election by the right wing media and people who have never visited this country.

[mamabadger]

Originally Posted by joyfulgrrrl

Honestly I don't know what UHC has to do with it - a shortage of midwives is a shortage of midwives, regardless of the funding source.

The only connection is, when midwives became fully covered and women no longer had to pay for them out of pocket, the demand for midwives immediately outgrew the supply. They can't train new midwives fast enough to keep up. Eventually they will catch up, but for now there are lengthy waiting lists in most communities, at least in my province.

[pjs]

I'm not trying to vilify your healthcare system.

I was trying to empathize with the original poster. I was trying to say that for me personally, as a woman who currently has access to homebirth midwifery care, it would be very difficult for me, and I'm sure hundreds, if not thousands of other American women, to face a reality where under a new healthcare system, or in Canada's case new rules/regulations, homebirth is no longer an option, where when and how you birth is basically the luck of the draw, because quite frankly, that really isn't the case here currently. And we're not talking about one ob versus another. A homebirth is a very different experience from a hospital birth, and yes, even a birth center birth. It's like comparing a vaginal birth to a c-section- sure you end up holding a baby in both cases, but how you got there is very different. They're not really interchangeable, and as a woman, I am terrified of my goverment telling me that they are.

What is being done in Canada to address the shortage? Just waiting and seeing and hoping that time will fix it? Or are there initiatives to encourage more midwives and more educational opportunities to become midwives? Is the government using the savings from current use of midwives to invest in future midwives or pocketing the change and expecting women just to deal?

[Say]

I'm not sure that you understood the original post in context. Canada has no new rules or regulations forbidding home births. Health care in Canada is federally funded, but provincially managed - therefore, while general guidelines concerning health care exist nation wide, there are variations of care in each province. The move to funded midwifery care (like the UK) is very recent and has not occurred simultaneously in each province. You can check the status from province to province here.

http://cmrc-ccosf.ca/node/19

The issues Bluegoat is having are the result of her living in a province that has just passed new midwifery legislation, and then again in a region that had few private midwives to begin with. As she pointed out, this is a matter of growing pains. It is a regional issue, not a national one. It's akin to a new law being passed in western Rhode Island - it doesn't affect all of the US. The ultimate goal in Canada is to have the funded midwifery model of care available to all women in all provinces.

What is being done in Canada to address the shortage? Just waiting and seeing and hoping that time will fix it? Or are there initiatives to encourage more midwives and more educational opportunities to become midwives? Is the government using the savings from current use of midwives to invest in future midwives or pocketing the change and expecting women just to deal?

Yes, just waiting and seeing and pocketing the change. That's what we do up here.

[CanBoo]

Originally Posted by Bluegoat

The regulated midwives can do home births as well as hospital births, but it can only be in their own health region. Eventually there will be midwives in all the regions, but no funding yet. My region is in the middle of building a new hospital and won't fund midwife positions until it is done, and then only if they can get funding. Legislation is great but it needs funding.

Can't you play the game? Give a different address in a different health region (family member, friend, or someone might be okay to do that for you in the local tribe) and then see if she will do it for you when you have to move unexpectedly in the last few weeks?