Pandemic puts Quebec's midwives in even higher demand

In short supply and high demand even in non-pandemic times, Quebec's midwives are straining to keep up as more women seek non-hospital births to avoid COVID-19 exposure and the health-care system adjusts assignments and responsibilities.

Midwives have seen a surge in demand since the beginning of the pandemic,  said Mounia Amine, president of the Regroupement des sages-femmes du Québec, which represents around 250 midwives in the province. 

"On one hand, in certain places, obstetrician services are more difficult to find," Amine said. "But also because there's really a wave of demand for births outside the hospital environment." 

But as requests continue to pour in and wait lists quickly fill up, the province isn't even close to having enough midwives to meet the demand.

Even before the pandemic, midwives across the province had lengthy wait lists because of a shortage of people choosing the profession. And the pandemic has exacerbated the shortage, because all student internships have been suspended. 

Julie Pelletier, president of Quebec's order of midwives, said the effects of the changes imposed due to the pandemic will be felt for two years.

"This is an effect of the crisis that we will have to manage," she said.

In Quebec, midwives usually perform about 4.2 per cent of the province's births, lower than the national average of 11.8 per cent.

To become a midwife in Quebec, students need to undergo training at the Université du Québec à Trois-Rivières for four-and-a-half years. Normally, about 20 students graduate from the program every year. 

No more home births

As with most jobs, midwives have had to drastically alter their practices to prevent the spread of COVID-19 and maintain physical distance as much as possible. 

About 95 per cent of women who seek out the care of midwives choose not to give birth in a hospital. Instead, the majority of them turn to one of the province's 12 birthing centres. 

In three of those centres, midwives have also had to take over the tasks previously handled by CLSC nurses as they head to the front lines.

At the Capitale-Nationale centre in Quebec City, as well as the Jeanne Mance and Côte-des-Neiges birthing centres in Montreal, midwives have had to take on post-natal follow-ups for patients. 

Those follow-ups include helping with issues nursing the baby, as well as checking up on babies who show signs of jaundice. 

"These aren't women who were being followed by midwives. It's really women who were followed by doctors, who gave birth in a hospital. So, it's really interesting," said Marie-Claude Masson, who has worked as midwife for more than 16 years. 

"I think that up to now, we've done about 100 evaluations." 

Masson said that the majority of the follow-ups are done over the phone whenever possible. 

"We're part of the system. We're really happy to help. We're really proud and happy to take part in the collective effort," Masson said. 

The province's midwives have also had to come up with contingency plans in case of a sudden loss of staff, or in case of a sudden overflow in affiliated hospitals. More than half of them have had to postpone or cancel their time off. 

Before the pandemic, about 20 per cent of the midwives' clients opted to give birth at home, but that is no longer an option. In March, the provincial order of midwives, in conjunction with Quebec's health ministry, suspended all home births in Montreal and all regions where birthing centres are located. 

"These are places where we can control who comes and goes," said Pelletier. 

"Disinfecting measures are applied. Whereas in a home, it's not as possible to have that type of control."