A midwife crisis

Joanne Jacyk, a 31-year-old Toronto-based environmental engineer, was all of five weeks pregnant with her first child when she picked up the phone to call a midwife—only to find that she was too late. “They were already full for my due date,” she says. “I thought, ‘I just got my blood test!’ I basically called as fast as I could.” Anxious, Jacyk got online, found a list of every midwifery clinic in the Greater Toronto Area, and phoned them all. “When I started getting calls back saying, ‘We can’t take you,’ I got really upset,” she says. “I didn’t realize how badly I wanted a midwife until I thought the option wasn’t there.”

There’s a joke circulating among the new-mommy set in Ontario, one of seven provinces where midwifery services are now or will soon be publicly funded: if you think you might be pregnant, first you call the midwife, then you pee on the stick. Jacyk, now the mother of a healthy three-month-old boy, was one of the lucky ones. Eventually, persistence and fortuitous planetary alignment landed her a placement. But last year in Ontario, 40 per cent of pregnant women who sought out midwifery care—roughly 6,000 of them—were turned away. Demand has so outstripped supply that in some parts of the province, finding a midwife is harder than securing the kid a spot in a decent daycare.

For many people, the word “midwife” still evokes patchouli incense and homemade yogourt. But midwives’ growing popularity, fuelled almost entirely by word of mouth, reflects the mainstream’s rapidly changing perception of their profession. “We generally have waiting lists every month,” says Andrea Lennox, a registered practitioner at Kensington Midwives in Toronto and vice-president of the College of Midwives of Ontario.

Because there are only 400 registered midwives to serve the entire province, savvy mothers-to-be have taken to “strategizing” to secure a coveted spot, says Raquel Parra, the clinic’s office administrator. For instance, if they don’t live within the clinic’s catchment area, they’ll lie about their address. They’ll lie about their intention to have a home birth (which well-informed women know places them higher up on the waiting list). And from time to time, they’ll fudge their due dates. “There are months in the year that you’re more likely to get a midwife,” says Parra. “December is really difficult because of the holidays. They know this so they’ll call me and give me a date several weeks earlier, and we’ll find out later when they do an ultrasound.” For midwives themselves, the impossibility of helping everyone who wants help can be stressful. “I know some midwives, when they’re going to parties, they lie and say they do something else for a living,” says Lennox, “because they just get bombarded.”

More than anything, midwife-mania is the product of deeply rooted problems within the larger maternity care system. With each passing year, the shortage of maternity care providers in Canada is becoming more pronounced. According to the Society of Obstetricians and Gynaecologists of Canada, there are currently only 1,650 OB/GYNs practising in this country, an estimated 500 of whom have shifted their practices away from deliveries, choosing instead to focus on gynecology, fertility and family planning. Moreover, roughly 34 per cent of the OB/GYNs now working are set to retire in the next five years.

At the same time, fewer family physicians are delivering babies—13 per cent in 2004, down from 36 per cent in 1990. In five years, reports estimate that up to 10,000 women in Ontario alone will not find access to a maternity care provider of any kind—not a midwife, not a physician, not anyone, until the day they find themselves doubled over with contractions in an emergency ward.

Compared with what is currently available in traditional medicine, midwifery is felt by many to be infinitely more personal. Instead of five-minute appointments with an obstetrician, clients get roughly 45 minutes with their midwife during each visit. Midwives have a policy of placing mothers-to-be at the heart of the decision-making process. They care for their clients through the entire labour process, and after the birth make home visits for the first 10 days to help families adjust to nursing and life with an infant.

In part, midwives say the surge in demand is a rejection of the “too-posh-to-push” school of maternity, whereby childbirth can be pencilled in like a reiki appointment—and tied to a broader social trend toward pared-down, natural living. Women who seek out the service are generally those with low-risk pregnancies who are looking for a de-medicalized experience—whether via a natural birth (midwives can’t administer epidurals, for instance) or, increasingly, a home birth—though midwifery offers, in many cases, the best of both worlds: approximately 75 per cent of midwife-assisted births in Ontario take place in a hospital so that, in case of an emergency, care can be swiftly transferred to an MD.

This emphasis on one-on-one care is something that Canada’s wildly overburdened obstetricians are simply unable to provide. Already they have an unusually demanding lifestyle. “Time-wise, they have to be on call on weekends and at night,” says Dr. André Lalonde, executive vice-president of the society, “whereas in family medicine they have fewer emergencies.” Moreover, in the last five years, he says, the society has witnessed a “feminization” of the specialty. “Now 80 to 85 per cent of new graduates in obstetrics are women,” he says, “and, rightly so, they want to have children of their own and family life, so they’re not going to do 250 to 300 deliveries a year. We have some people doing 450 or 500 deliveries a year. That’s not going to happen. They want to work reasonable hours.”