When the contractions started signalling that Miriam Manley’s first daughter was on her way, Manley tucked herself into her own bed with the lights off and the temperature low–she was in the zone.
But when it was time to go to the hospital the lights were too bright, she felt hot and sweaty and there were people in the room that she didn’t know.
“It wasn’t super negative but I remember thinking ‘next time if I had more control over the situation, over my environment that it could be quicker and easier and more pleasant’,” she said.
|Miriam Manley had both of her children under the care of a midwife and prefers their maternity care to family physicians. (Submitted)|
The second time around Manley was determined to have a home birth, but the midwife who cared for her first pregnancy was no longer practicing in Revelstoke and family physicians cannot accommodate home births.
Manley decided to travel to Salmon Arm in order to have midwifery care and had her daughter Juniper in a hotel suite in Salmon Arm in September.
“I am really happy, ultimately, with how the birth went,” Manley said. “But it did involve driving down to Salmon Arm whilst in labour. Which was a bit sketchy.”
Manley is one of 17 women from Revelstoke who have travelled to either Vernon or Salmon Arm to access midwifery care since the midwife practicing in Revelstoke left in 2016. The other 80-100 babies that are born in town every year are attended by family physicians at the Queen Victoria Hospital.
Midwives offer primary care from early pregnancy, through labour and birth and up to three months after birth. Their care is covered under MSP for women who choose to access it. The midwifery care model is relational–midwives support women in making informed choices about their care. They also provide continuity of care, which means each woman has a known care provider in attendance at her birth and low risk women have their choice of birth place.
Though she has an amazing family doctor, Sophie Méley-Daoust said that having her second child with a midwife felt more personal. The appointments were longer and more flexible, her midwife asked how she was feeling and was available to answer questions via text or over the phone in between appointments. She said the process felt more collaborative as well, with the midwife explaining the options for testing as her pregnancy progressed. And after birth, the midwife came to Méley-Daoust’s home for the one-week check up.
“Nature does it’s thing and midwives seem to go more with that,” she said.
According to Méley-Daoust and Manley, one of the midwives that practices in Salmon Arm lives and would like to practice in Revelstoke, but is unable.
We reached out to the midwife but she said she didn’t want to comment at this time, however, Julie Lowes, the hospital manager, said that there have been no applications for midwife hospital privileges in Revelstoke since the previous midwife left.
When asked if a midwife was discouraged from even submitting an application, Lowes said “I haven’t heard of anyone saying ‘don’t apply’.”
Méley-Daoust and Manley agreed that though the family physicians in Revelstoke are good, women should have the choice to use a midwife.
Why should women in Vancouver have access to a midwife and not Revelstoke? Manley asked.
Birte Paschen worked as a midwife in Revelstoke from 2008 to 2016.
“The family doctors were very welcoming when I moved there,” Paschen said in an email. “Always respectful, they integrated me into the hospital meetings and helped me out whenever I had a question or needed something.”
Despite their support, Paschen was working too much trying to be available for her clients 24/7 and with only 30 births a year, it was a tough go making a living.
“It wasn’t (the doctors) that ended midwifery in Revelstoke, it was me,” Paschen said. “As long as there is no better system in place for a midwife in such a small community I’m going to say that it is not healthy for a solo practitioner at all.”
|Victoria Haines is a doctor at the Selkirk Medical Clinic who delivers babies. She said she would happily work with a midwife in Revelstoke. (Submitted)|
Victoria Haines, a family physician at the Selkirk Medical Clinic, praised the midwifery care model, saying that since working with midwives she has changed how she cares for pregnant women.
“I’ve actually started doing a home visit after my ladies deliver their babies because I think it makes perfect sense,” Haines said.
She added that she and the other maternity care providers would be more than happy to work with a midwife again, providing that the practice was sustainable.
“To be honest, you don’t want someone that’s on call 365 days a year, with the fatigue and discouragement that comes from that, there helping you with your baby in the middle of the night,” she said. “It’s not fair to them or to you.” .
Haines said that she and the other maternity care providers in Revelstoke were sad to see Paschen go.
“In fact, when she started saying ‘I don’t think I can sustain my practice here anymore’, I investigated if there was any ways we could offer her supports and maybe a different practice model that would allow her to stay,” Haines said.
At the time the college of midwives had strict policies that didn’t allow for a midwife to share care with family physicians.
Since that time, that has changed.
“They are moving in a direction where they realize in rural communities that isn’t always possible if you want to share the load,” said Katherine Brown, Revelstoke Health Services Development Project Manager.
Last month the Revelstoke Chapter of the Rural and Remote Division of Family Practice’s application to Shared Care BC for funding to work on an inter professional collaborative approach to maternity care was approved.
For the first part of the project Shared Care granted $10,000 to the chapter to engage with the community, both patients and health care providers, to identify the gaps and develop the scope for the project.
“The second phase will be $50,000 to implement whatever said collaborative model we are looking to implement,” Brown said.
So far there have been eight communities that have worked with Shared Care to develop a collaborative maternity care model. Brown said that the work group will have access to that previous information and build their own model from there.
“We want to keep those 17 women home, we want to keep those 17 women off the highways,” Brown said. “We don’t want people to travel for prenatal appointments, that is unacceptable.”
As well as addressing concerns from patients in the community, the project will look at the reasons a solo midwife practice is not sustainable in Revelstoke.
|A group shot of some of the members of QVH’s obstetrical team: Dr Mostert, Dr. Molder, Dr. MacDonald, Dr. Brown, Dr. Veale, RN Nadia Salon, Nursing Coordinator Deena Crane, Dr. Haines, RN Jen McLafferty, Health Services Manager Julie Lowes and Dr. Rennie.|
Payment policies and funding being one of the concerns, Brown said that the college of midwives have certain rates while physicians adhere to MSP payment policies.
“The two don’t mesh very well.”
Another issue, Brown said, is ensuring there is enough clinical work to keep family physicians who are also surgeons or anesthesiologists living in the community.
“In our case we actually have seven physicians who practice obstetrics now,” Brown said. “Four of them can provide Cesarean sections and we have three anesthesiologists here locally as well.”
If a midwife were to care for more patients, there would be less patients for family physicians and they might not stick around, Brown said.
“For us it is more of a right to choice.”
With the Shared Care funding, the division will look at the funding model as well as sharing on-call duties, among other things.
“There are so many cogs in this machine and so many different organizations and there is politics and all of this so that is why they fund these projects in the amount of $60,000 because of coordination that has to occur between so many different groups is kind of insane,” Brown said.