The Final Push Making midwives part of the Nova Scotia health system

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From the Atlantic Centre of Excellence for Women's Health

Leading experts in the field of midwifery are calling on the Nova Scotia government to make midwives a central part of health services across the province.

"Our focus is to improve maternity and newborn care services for women and their families. An integral part of improving these services is for women to have access to the publicly funded services of midwives," says Dr. Christine Saulnier, Senior Research Officer and Coordinator, Midwifery and Women's Reproductive Health, with the Atlantic Centre of Excellence for Women’s Health (ACEWH).

Health experts and activists joined the ACEWH in Halifax this year by celebrating the International Day of the Midwife with a public panel entitled, "The Final Push: Making Midwives Part of the Nova Scotia Health System." Dr. Saulnier was one of four panelists who gave an overview of the current status of midwifery in Nova Scotia and the long-range goals of those seeking change.

At present, midwives in Nova Scotia have no formal or legal standing and are able to work only in a private, fee-for-service manner. Most of the births they attend are at home, but some do occur in hospital where midwives must take a supportive, rather than care management, role.

Over the past 15 years, two governments have failed to move forward on recommendations to integrate midwife services in the province. Last June, the government convened The Working Group on Primary, Collaborative Maternity Care to explore, once more, how that can be accomplished. The mandate of this group came to an end in June 2005.

"Women choose midwives because they want to be able to make fully informed choices and to be the primary decision-maker around their own care," says Kerstin Martin, Vice-President of the Canadian Association of Midwives. "These choices include where to give birth, whether that is in a hospital, in a birthing center or at home. Research also indicates that women under midwifery care are happier with their childbearing experiences and more successful with breastfeeding."

Currently midwives are legislated and regulated in Quebec, Ontario, Manitoba, Alberta, British Columbia and the North West Territories—and publicly funded in each of these areas except Alberta. There are 450 practicing midwives in Canada. The standard of education is a four-year university degree available in Ontario, Quebec and British Columbia.

"We are hopeful that Nova Scotia will join the mainstream and accept midwives as part of Nova Scotia’s health care system — and be covered by MSI [Medical Services Insurance; medicare]," says Octavia James, Co-Chair of the Midwifery Coalition of Nova Scotia, and a consumer of midwifery.

"Research indicates that a midwife's care is as safe as physician's care, and requires far fewer medical interventions," she notes.

This means lower rates of Caesarean sections, less vacuum and forceps deliveries, and fewer episiotomies (surgically enlarging the vagina at birth). Subsequently, health care costs are reduced.

Midwives and their supporters throughout Nova Scotia remain cautiously optimistic that the government will announce plans to introduce midwifery legislation sometime this coming year, says Dr. Saulnier.

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All About Midwives

  • Midwives are autonomous, primary health care professionals, experts in normal pregnancy, labor, birth and care of the newborn. Midwives care for healthy women throughout pregnancy, conduct deliveries on their own, and continue follow-up of the mother and baby for six weeks after birth.
  • Midwives have the knowledge to detect abnormal conditions, to collaborate with physicians and other health professionals, and to execute emergency measures in the absence of medical help.
  • Midwives are an essential component of most maternity services and the senior attendant at a majority of the world’s births. Canada was the only developed nation to exclude midwives from its health care system, but has experienced a midwifery renaissance in the last decade.
  • In Ontario, for instance, there are now 266 midwives delivering 9000 babies each year.

Why women want midwives

  • Women most often choose midwives for their expertise in supporting normal birth. Midwives regard childbirth as a natural physical function of a woman's body -- something women do well when adequately supported.
  • Women also choose midwives to receive continuity of care, so that women get to know the midwife who will help them deliver their baby, and who will provide on-going home visits for postnatal and breastfeeding support.
  • Women who choose midwives want to give birth with little or no medical intervention, in the environment where they feel most comfortable, attended by familiar and trusted caregivers to create a birth experience that is joyful, empowering and safe.

Why integrating midwives into the Nova Scotia health system is a good idea

  • Midwifery care is safe, and offers the added benefit of reducing the number of medical interventions. For instance, in Ontario, midwives have the same outcomes as family physicians but a 30% lower rate of Caesarean section, 50% fewer vacuum and forceps deliveries, and perform 50% fewer episiotomies (a surgical enlargement of the vagina at birth).
  • New Ontario mothers have twice the rate of early discharge and 65% fewer re-admissions to hospital with midwives.
  • The Ontario Minister of Health recently stated that a midwife’s course of care is, on average, $800 cheaper per hospital birth and $1800 cheaper per home birth, due in part to lower rates of intervention and higher rates of early discharge from hospital. A new study in Alberta confirms this finding, and estimates the savings to be between $700 and $1100 per birth.
  • A study in British Columbia comparing a similar low-risk population of women giving birth in hospital found that midwives have a Caesarean section rate of 12% while GPs had a rate of 18%. Among those women planning to give birth at home, the rate of Caesarean section was a low 6.5%.

For more information, visit:

*The Atlantic Centre of Excellence for Women’s Health

*Midwifery Coalition of Nova Scotia

Midwives in the Balance: Partnership and Practice for Normal Birth

November 9-11, 2005
Halifax, Nova Scotia

For details, visit: Or email: