Birth of new midwifery regulations greeted by a roomful of uneasy citizens
Labrador Grenfell Health
Despite the announcement of a new report, Implementing Midwifery in Newfoundland and Labrador, which will guide this province’s establishment of the practice, expectant moms across the Northern Peninsula and Southern Labrador are none too happy.
According to the report, which was presented by Minister of Health and Community Services Susan Sullivan on Feb. 27, it will take upwards of five to seven years for midwifery to become publicly funded.
Having received a plethora of letters and signatures from disheartened people of his district and beyond, Straits-White Bay North MHA Christopher Mitchelmore, who was present during Minister Sullivan’s announcement, was quick to express his disappointment at the slow turnaround in the public system.
While progress is forthcoming, he’s upset by the approach and lengthy delay when it comes to regulating the profession of midwifery in Newfoundland and Labrador, given the fact that midwives were already practicing in the Labrador-Grenfell Health region. The Grenfell Health Board had a long-standing agreement, which recognized the practice of midwifery at hospitals and health clinics under their administration. Just recently, they were forced to alter the midwives’ realm of duties at Curtis S. Memorial Hospital in St. Anthony after their insurance company cracked down on the unregulated service by stating that a doctor must now deliver all babies.
The policy fails to provide coverage for a midwife delivering, or assisting in delivering, an infant while acting as a midwife. Coverage is only provided when the midwife is acting or administrating in a nursing capacity.
“The Minister indicated that those wishing to avail of midwifery as a private health service would likely be able to access within a year; however, those fees would not be covered by MCP … as well, many private health insurance providers will not cover the services of midwives,” he said. “What is more troublesome is the time lag for women to access midwifery in a publicly funded setting.”
Mitchelmore believes that government’s failure to establish regulations ultimately diminishes the role of the midwife at Labrador-Grenfell Health and if not adequately addressed, he said, the service could disappear from the local public health care system. “This will create a social divide in the interim for women and families, permitting only those who are able to afford such a service, which will basically limit the practice of midwifery to larger urban centers,” said Mitchelmore.
“Midwives at Labrador-Grenfell Health have a proven track record, delivering the majority of babies in that hospital setting … this is another instance where government is failing to deliver improved health outcomes that are cost effective.”
With midwives now limited to which duties they can perform at Curtis S. Memorial Hospital, Mitchelmore believes a number of implications will quickly follow.
“It will mean that women and families who have utilized a midwife to deliver a child in the past will not have that option – Obstetricians or General Practitioners will now be more involved in the delivery process,” he said. “This will come with additional fees, on-call hours and increased workload for a number of other health professionals. Also, additional training will be required for nurses, who do not have the experience in the delivery room as our dedicated midwives.”
Mitchelmore has been steadily conducting research, listening to constituents, writing key decision makers and speaking to the media. He said he will encourage people to write the Premier, Health Minister, and the Health Authority and he, himself, will continue to press the matter in the House of Assembly.
And to accompany his visit to the HOA, Mitchelmore has the signatures of several hundred petitioners that have been sent to his office, not including the more than 500 already present on an on-line petition.
“Petitions are citizen driven and, in this instance, ask government to take action on how midwives at Curtis S. Memorial hospital, and those served by them, will be negatively impacted,” said Mitchelmore. “Likely the number of petitioners will reach in the thousands, as many petitions have yet to be collected.”
He said that Labrador-Grenfell Health has a working model that has been successful for decades and acts as a model for the province.
“We were always innovators in the North,” stated Mitchelmore, drawing attention to the air ambulance services, the first colon cancer-screening program and the integration of midwives into a publicly funded system.
“We are not laggards on the Great Northern Peninsula, we are leaders in health care and we must send a message to government that there are models in which we can get better value and improved health outcomes, because midwives are a valuable part of the health care system.”
Provisions needed says CEO
Labrador-Grenfell Health CEO Tony Wakeham fully intends on providing the same coverage for people of the Northern Peninsula and Southern Labrador who have their babies delivered at Curtis S. Memorial Hospital, but provisions needed to be made, he said.
“We want to make sure that our staff are protected from a liability point of view, and that was the reason we had to stop that particular piece,” he said, referring to their disabling of a midwife’s authority to deliver babies. “But, as far as the service we provide, the midwives are part of an excellent team that consists of two obstetricians and two pediatricians, as well as a number of local GPs who are involved in the delivery process.”
He said the nurse midwives who work at the hospital “will continue to provide the same type of coverage that they used to for expectant mothers, up to the point that the insurance policy allows.”
As far as the pre-natal and post-natal care goes, he said the public could expect midwives to perform as before.
“They will still be present for the labor process, for consultations and for assessments … they’ve always done those things, and they will continue to do them,” he said. “They just won’t deliver the baby, but they’ll still be a very important part of the team.”
A team that Wakeham assures is “very dedicated, and very professional”, and whom he believes will not receive a significant burden to their workload as a result of the slight shuffle of duties.
“Last year, for example, we delivered 83 babies in St. Anthony, in total,” he declared. “And in terms of an overall look at babies being born, that isn’t a huge number … I’m confidant with the team we have in place.”
While he recognizes the one significant part of the midwives’ duties that will no longer be performed in St. Anthony, Wakeham assures that the quality of care will be the same.
“Our first priority is to protect employees and, from a liability perspective, we have no choice until such time when regulations come into effect that allows us to obtain that coverage,” he said.
“I would hope that people will still continue to receive the same quality of care that they’ve received in the past, and we certainly have a team there that can provide it.”