I Won the Lottery

My mum has a saying. “You were born in Canada – you won the only lottery that matters.” Although we have a long way to go with regard to certain marginalized groups, I think she’s basically right. We here in Canada are exceptionally lucky to have such good health care and education systems, especially compared to the US. It doesn’t always seem that way – and there is certainly room for improvement in these systems – but relatively speaking, we really are privileged.

On a Thursday last November, I won another lottery of sorts. That was the day that I got a call saying I had been accepted as a client with a midwifery practice based at the Birth Centre.

Two months pregnant with my second child, I had a lot of hopes for this pregnancy and birth. With my first, I had a very difficult birth, and the weeks and months that followed were fraught with a long and painful recovery, almost every breastfeeding issue under the sun, and the emotional challenges of dealing with a colicky baby. Having midwives rather than an OB was the biggest thing I hoped to do differently this time around. The continuity of care (midwives care for the woman and her baby as a pair from her first prenatal appointment until the baby is about six weeks old) and support offered by midwifery just made so much sense. It sounded like a much more logical and beneficial option for someone with a normal, low-risk pregnancy, and I was already sold on its benefits, at least on paper.

Then, when our son was nine months old, my sister-in-law had a planned home birth at our house (their house was under construction at the time, and they were staying with us for a few weeks) and seeing was truly believing. From the expert way the midwives helped her during labour and birth, to the exceptional support they provided her during the days and weeks that followed, I almost couldn’t believe that such an amazing model of care existed. I could see how having midwives the first time around would have been tremendously helpful for me. I crossed my fingers that I would be able to beat the odds the next time I was pregnant; reports at that time were saying that at least 75% of women seeking midwifery care were turned away due to the shortage of certified midwives in Manitoba.

So, last fall, the morning I had a positive home pregnancy test, I called the midwifery intake line, and then began the long wait. At last, just when I was beginning to think that I was out of luck, I got a call saying I was in. I was so elated that my hands shook as I called my closest family members to let them know the good news. From that point forward, my prenatal care was drastically different from that I had experienced the first time.

For starters, my prenatal appointments lasted on average, an hour. The first one was an hour and a half! During that time, my midwives (I had a team of three, and over the course of my care had appointments with each of them, in rotation)  wanted to know all about my first birth and postpartum experiences. As I told them about my physical and emotional difficulties and how I managed them, I could tell were really listening. When I explained my hopes for a different experience this time, they were completely encouraging. When we discussed where I hoped to give birth this time, they were all confident that I could have a home birth if that’s what I wanted. I left my first appointment on a bit of a high. Who knew health care could be so… enjoyable?! During subsequent appointments I was provided with plenty of information (the midwifery model expects the mother to be a full and engaged participant in her own health care decisions) and options. All prenatal tests were optional. In my case I opted to have the 20-week ultrasound and group B strep tests, but declined the maternal serum screen and gestational diabetes screen, and decided on these with the full support of my midwives.

Contrast this with last time. When I left my doctor’s appointments during my first pregnancy, usually I felt disappointed – I almost always waited 30 minutes to an hour to see the doctor, and then would be out the door in about five minutes.  My doctor was very busy and often zipping back and forth between the office for appointments and the hospital to deliver babies. We once saw her, just before our appointment, in the elevator in her scrubs – she had just delivered a baby! My husband accompanied me to every single one of those rushed and perfunctory prenatal appointments, but when I introduced him at the first one, my OB told him point blank that she “didn’t remember husbands”. While I believe she was a good doctor, I didn’t feel as though I had any sort of relationship with her, or that she knew anything about what my hopes, preferences, and values were. She delivered my baby, stitched me up and then I didn’t see her again for six weeks. At my six-week postpartum checkup she didn’t even ask me what I had named my son. I am certain she wouldn’t have recognized me if we’d passed each other on the street. Still, I don’t blame her for the way things went. The system is not designed for these specialized doctors to spend much time with patients whose pregnancies are progressing without any complications.

This time around, my midwives were always asking about not just me, but my family. We were encouraged to bring our then-2 year old son to the prenatal appointments and have him participate in listening to the baby’s heartbeat, measuring my belly, etc. The Birth Centre has a wonderful child-minding area and service, which is so appealing to kids that when we had to leave it, my son cried the whole way home because he wanted to go back and play. In the wake of our new arrival, they wanted to know how my husband was feeling. How was our son adjusting? How was I coping as a mother of two, and were we finding our rhythm as a new family of four? They asked us and they really wanted to hear our answers. And because the team works on a rotation of being “in clinic” and “on call”, I always knew who my next appointment would be with, and that it would begin on time. I never once felt rushed, and was always provided with ample time and opportunity to ask questions, explore issues, or just talk over things that were on my mind.

Ultimately, I had a peaceful and uneventful home birth – just what I was hoping for! The midwives were amazing – our daughter was born just after 5am and by 9am I was cleaned up, tucked in bed and resting with my family with a cup of tea and a muffin from my stash of freezer meals. The midwife called later that day to see how I was doing and then came to my house regularly over the next two weeks. Not having to leave the house for appointments was so wonderful; it meant that in those hazy days of newborn exhaustion, we could just focus on taking care of ourselves. I will always cherish one particular home visit. My mum, who was visiting from Alberta, made my midwife and I some tea and we all chatted as I finished nursing the baby. My midwife asked my mum about her own experiences and my mum said that when she gave birth to my brothers in the 1970s, her doctor told her she’d have to write the St. B hospital board to obtain permission for my dad to be in the delivery room with her! How times have changed.

When I left my last postnatal appointment, I cried as I said goodbye. Throughout the months of my pregnancy and the six weeks that followed, I became very attached to my wonderful midwives (must have been all that oxytocin bonding us!). They were an integral part of such an intimate and special time of my life, and for their outstanding care I will always be grateful.

I could write a novel about how my care was different this time, but instead I’ll just mention a few other instances that stand out in my mind as examples of the exceptional care I received:

• At one point in my third trimester, I experienced some bleeding at 11pm on a Friday night. I paged my midwife and she met me just after midnight at the hospital to check things out, do a nonstress test and discuss a plan. If I’d not had a midwife in this scenario, I would have been waiting in the emergency room for who knows how long, or in triage at the maternity unit, explaining my situation to countless nurses and doctors who’d essentially be strangers. Instead, in this scary and worrisome moment, I had reassurance and empathy from someone I already knew well and felt totally safe and comfortable with. Even when I was admitted to the hospital for observation overnight, my midwife called me first thing in the morning to see how I was.
• A week or so after the birth, I was still experiencing some problems with getting my daughter to latch properly. I toughed it out for a while and then decided to call for help. I paged my midwife and she came over two hours later to help me out. Then she called in an ointment prescription for me and made sure it would be ready for pickup that night. Without a midwife, I would have had to seek out breastfeeding support in the community*, then see my own family doctor for the prescription, a process that would have easily taken at least a few days – which anyone who’s had breastfeeding issues knows can be too long to wait. Instead the problem was dealt with in just a few hours, without me having to leave home.
• Even after I was discharged from care, I called with questions a few times and my midwives were very helpful in directing me towards the support that I needed.

*I don’t mean to devalue the marvelous resources we do have – free breastfeeding support clinics that run almost every day of the week around the city, staffed by trained, wonderfully compassionate professionals. These are a lifesaver for many, many mothers, myself included last time. I’m sure I will be accessing them again now that I have been discharged from my midwives’ care. It’s just that when you have such a new baby, getting support from someone who already knows you and your baby, in the comfort of your own home, makes a huge difference.

All in all, I can’t overstate the helpfulness – and efficiency – of being treated as a mother-baby pair by a small group of professionals with whom you have an ongoing relationship. In the traditional model, you have public health nurses, but they’re not talking to the pediatrician, who’s not talking to your own doctor, who’s not talking to breastfeeding support nurses/lactation consultants… you get the picture. Individually, I know these professionals are all doing the best they can, but the system is not set up for them to work together, which is what needs to happen for mothers and babies to get the best care possible.

I think it’s important to point out here that midwifery care isn’t your typical style of health care, which some have aptly called “sickness care”. Midwives view birth as a normal part of life, something that women’s bodies are designed to do, and not something inherently risky. They also take a holistic view, recognizing that pregnant women are more than just measurements and test results; they are people with emotions, hopes, wishes, and baggage, and midwives want to know about it all, because it all affects pregnancy, birth, and the eventual family. And midwives will support you whatever your choices are: to give birth in the hospital, at the Birth Centre, or at home; to have drugs for pain relief – or not; to have prenatal and newborn testing and procedures – or not. At the end of the day they are they to educate and support women and their families in their own choices, whatever those choices may be.

I was thrilled to see that a recent study from the Cochrane Review (the gold standard in evidence-based health care) made major headlines when it found that midwifery care is ideal for most pregnant women. Let me be clear: there is an important place for obstetricians, and we are lucky to have skilled ones when we need them. But as the Cochrane Review study confirms, most low-risk pregnancies would be best served by midwives.

From what I understand, the delays in certifying more midwives to work in Manitoba is quite complicated, but I certainly hope that the parties involved will be able to establish and expedite the necessary processes as soon as possible. Having midwifery care is something that every woman deserves, if that’s what she so desires. I’d be remiss if I didn’t also mention that it costs the province significantly less, with equally good outcomes. Last I heard, the waitlist for midwifery care in our province is nearing 80-90%. We can and must do better for women and families.  In the meantime, I am sending letters to the powers that be encouraging them to support and improve access to midwifery, and telling anyone who will listen about my positive experiences. And if you’ve read this far, I hope you will join me in pushing for more midwifery services in Manitoba. Because no one should have to win the lottery to get a midwife.