Nova Scotia's midwifery association 'disheartened' by lack of funding in provincial budget

As Nova Scotia works to eliminate some burdens on the health-care system, the provincial association of midwives is asking why it was left out of the latest budget.

Nova Scotia's budget was released last month, and focused primarily on health care. 

Jessica MacDonald, the president of the Association of Nova Scotia Midwives, said she was surprised by the exclusion of midwifery, despite many calls to expand the program and increase the scope of practice for midwives.

"It's certainly something that we keep bringing to the table that hasn't been met with a lot of acceptance in terms of moving that forward, but it's something we continue to fight for," MacDonald told CBC Radio's Information Morning Cape Breton.

CBC News requested an interview with Nova Scotia's health minister but a spokesperson said they were unable to accommodate the request.

"The department continues to focus on stabilizing existing midwifery programs and working with Nova Scotia Health to see how we can increase access to the service," said an emailed statement from the ministry.

MacDonald spoke further with CBC's Brittany Wentzell about the situation.

Their conversation has been edited for clarity and length.

Currently midwives are based in Antigonish, Lunenburg and the Halifax region. Over a decade ago, an independent study recommended expanding the program to other areas, including the Tri-Counties, the Annapolis Valley and Cape Breton, but that's never happened. Has that ever been floated by you by our current government?

Certainly in our advocacy work with all governments, we bring this study forward and talk about those recommendations that were made. One of the recommendations was to have 20 working midwives in the province by 2017 and here we are in 2023 and we know that we have 16 positions across the province, and no expansion to those counties that you've mentioned. 

It's certainly something that we keep bringing to the table that hasn't been met with a lot of acceptance in terms of moving that forward, but it's something we continue to fight for because we certainly know that the demand is there.

You know, that's a way that we can grow midwifery — by not only expanding the practices that currently exist in the province — but really increasing access to those living in areas that don't have access to midwifery care and really want these services.

Given the recent changes to expand physicians assistants and that the budget was so focused on health care, were you surprised to not see any inclusion of midwives?

ANSM was very disappointed and I personally was as well, to see another provincial budget announcement without the investment in the expansion of midwifery services. 

I mean we're talking about a budget that has $6.5 billion invested in health care, and so to not have mentioned a midwifery expansion is extremely disheartening. This is echoed by our midwives working across the province, as well as former clients that understand the value of this type of care and really want to see that grow.

In Nova Scotia, we're lacking a lot of family physicians and we're seeing a lot of burnout among nurses. How can midwives play a role in helping alleviate some of these pressures?

This government talks a lot about optimizing scope of practice and I think that's what we're looking at as well in terms of increasing the number of midwives is going to alleviate pressures on family physicians and our obstetric colleagues by providing prenatal care for low-risk populations. This frees up our high-risk specialists to do that high-risk work. 

We also know that in terms of the births that are happening in Nova Scotia, only five per cent of births are led by midwives so that's 95 per cent of births that are being conducted by obstetricians and family physicians. 

So if we were able to increase this number, we're allowing some space for family physicians to work in other ways that aren't doing prenatal care, as well as our OBGYNs [obstetrician-gynecologists].

We can also increase access to newborn care and postpartum care and breast-feeding support by providing care in the first six weeks after babies are born, like we already do with the clients that are in midwifery care. But expanding the program would mean more people are being followed in those first six weeks, which is a very crucial and vulnerable time.

Certainly, we also know there's lots of studies out there to support that midwifery care leads to a decrease in intervention, lower caesarean section rates, shorter hospital stays —  so less time in the hospital because we're providing community-based care both through home birth or just the home visits that we provide postpartum. That's also shortening the duration of time people are staying in hospital, allowing for some more beds to be open and I guess alleviates that burden on our nursing staff as well.

What's next for you? I know you do a lot of advocating. Is there going to be any kind of particular push in the coming months?

There is. We certainly know that with this recent budget announcement and the lack of midwifery being mentioned in this budget, it has certainly given us a bit more drive to really advocate for the profession and the growth of the profession across the province. 

We do have a couple government relations meetings coming up to talk about growth and certainly, bring all these points forward and just hope that by continuing to do so we're going to start to see some change in how midwifery care is being provided across the province.