Two years after new law, only five midwives left in Saskatchewan

When Tricia Hutton talks about the home birth of her second daughter, her face brightens.

Just more than four weeks ago she delivered baby Lyndsey with the assistance of one of the Saskatoon Health Region’s (SHR) five midwives.

"We just weren’t really comfortable with the hospital environment. We felt that decisions would be made for us without us making them for ourselves," Hutton said. The home birth process went very well.

"It was phenomenal," she said of the quick birth and the care she received after from her midwife. "There was no intervention that we didn’t want. We made all the decisions."

Hutton has now become an advocate for improved midwife care for all women and shared her experience at an International Day of the Midwife Celebration hosted by the Saskatoon Health Region (SHR) Wednesday. A little more than a year ago the SHR began its midwife program in the city, employing five full-time midwives. Since February 2009, the midwives have delivered more than 170 babies.

Still, many say there is a need for more midwives and expanded care. Saskatoon is the only place in the province where mothers can choose the care of a midwife instead of a physician.

Debbie Mpofu cradled Hutton’s baby as her mother spoke to the crowd. Mpofu was the midwife at baby Lyndsey’s birth and is the province’s first employed midwife.

Midwifery regulations were introduced in the province on March 14, 2008, and three days later she was employed.

She received initial training in England where she lived with her husband. When she moved to Saskatchewan she was "shocked" to find she was not able to practise here. As soon as she was able, she went to Ryerson University to receive training in Canada and then helped to set up the midwifery program in Saskatoon.

"This was just a fit," she said.

Saskatchewan lags behind neighbouring provinces in the number of registered midwives. According to Canadian Medical Association (CMA) statistics, Manitoba has 52 and Alberta 45. There are only five provincially funded midwives practising in Saskatchewan. These midwives have a heavy caseload and are forced to turn women away. Many women are also asking for the SHR to expand beyond city limits.

"We don’t have funding from the provincial government yet," said Sheila Achilles, the director of primary health with the SHR. The biggest issue, however, is not the funding but the lack of trained midwives in Canada.

"There’s not five more to be had," said Nancy Klebaum, the manager of the Saskatoon midwifery program. Klebaum concedes there can be a wait list of up to five women per month.

"Midwives are a scarce resource," said Margaret Baker, a director in the primary health services branch of the provincial Ministry of Health. She said the province is currently focused on expanding services. Regina now has funding for two midwives, and the Cypress Regional Health Authority recently hired one, with funding for two positions. The Prince Albert Parkland and Athabasca Health Regions are in the planning stages.

"The goal is to expand the program, but that really will be dependent on the availability of midwives who can become licensed in the province," Baker said. The intent is to move towards a provincial program with more equal access.

Hutton believes savings to the health-care system would be great with more practising midwives, pointing to 2007 Association of Ontario Midwives research into the cost of midwifery services compared to physician care. On average, a midwife-assisted birth costs the health-care system $800 less if a birth takes place in hospital and $1,800 less if the birth takes place at home. A midwife can care for 40 patients per year on average, which indicates the government could save between $32,000 and $72,000 in health-care costs annually per midwife employed.

"It’s definitely a huge, huge accessible way to limit the health-care costs, while at the same time giving the Saskatoon and Saskatchewan residents what they’re after. There’s a crying need for it," Hutton said.

Allowing midwives to attend to low-risk mothers also gives physicians more time to focus on high-risk pregnancies.

"We haven’t gone to the hospital, she has not had an epidural. We haven’t used several nurses for her care, she has not had any drugs, she has not used a hospital bed. Now, you work out the savings there," Mpofu said.

The province does offer bursaries to midwives completing training, as well as support to internationally trained midwives completing the accreditation process.

Only four provinces in Canada currently offer midwifery programs.

Janice McCaskill is completing her midwife education through a distance learning course based in the United States. She began the work in 2003.

"I didn’t want to leave Saskatchewan, I wanted to stay here," she said. The Unity-based mother is worried there won’t be a job for her when she’s done.

"There’s not a lot of positions unless the government decides to fund independent practice," she said. Liability insurance costs between $20,000 and $50,000 per year. With a full-time caseload of 40 births per year, that would amount to $500 per client. She’d like to see the government underwrite the cost of insurance for private practitioners.

While independent midwives can practise in Saskatchewan, at this time public funds are only dedicated to regionally employed midwives, Baker said.

jstewart@sp.canwest.com