Pregnancy & Breastfeeding

Midwifery care helped me to learn about trusting my body and about alternate ways
to help any discomfort that I had. - Elizabeth W.

In Canada, there is a long history of many generations of women helping women with their births. Many aboriginal midwives played a central role in their community with their birthing wisdom and particular spiritual connection to the family. Neighbour women and midwives working within their ethnic communities were usually specially chosen and respected as the primary helpers at births. As well, numerous women in Canada over the years, out of choice or necessity, birthed alone or with the support of family members.

This work of women acting as midwives was disturbed by the gradual medical takeover of birth and by the transportation of women to centres where hospital deliveries and the possibility of anesthesia and instrumental deliveries were available. Within two generations, midwife-attended births had almost completely disappeared in most parts of Canada. Although it has been estimated that 80% of the babies born into the world are born into the hands of midwives, Canada was, until recently, one of a few countries in the world with no legalized midwifery care.

However, in Canada, consumers began to critique the medicalization of childbirth in the 1940-50’s and by the 1970’s the women’s movement was actively attempting to demystify knowledge around birthing. In many parts of Canada, consumers began to lobby their provincial governments for the legalization of midwives to provide more women-centered care: care that is based on respect for pregnancy as a state of health and childbirth as a normal physiological process and a profound event in a women’s life. In many provinces, these efforts have resulted in midwives becoming publicly funded, regulated health professionals with university midwifery education programs; midwifery has moved into the mainstream of many provinces’ health care systems.

The following is a description of the model of midwifery care that has been developed in many provinces. Central are the woman and her baby, surrounded by her personal supporters as defined by her. Midwives known to the woman (usually two, but no more than four) surround them and provide care that is continuous and non-authoritarian for the woman and her baby during pregnancy, the birth and for six weeks postpartum. At least one prenatal visit is done in the woman’s home and at least four home visits are made in the days following the birth. Other visits usually take place at the midwifery clinic. A midwife known to the woman is on-call 24 hours a day to respond to questions and concerns. Visits of between half an hour to one hour are arranged between the woman and midwife so that a relationship develops over time, and information is shared so the woman can make informed decisions around her care.

The midwife provides support for the woman throughout her labour. This support involves not only the on-going attention to the “monitoring” of the baby and the woman, such as the checking of heart tones of the baby, the woman’s vital signs and the physiological progress of labour; it also involves providing (or supporting others to provide) hands-on supportive care and encouragement when wished for by the woman. Midwives wish to respond to the woman’s individual situation, her belief systems and her own personal style of moving through pregnancy, labouring, birthing and the mothering of her baby.

In the midwifery model, women are encouraged to give birth in the setting of their choice and settings in which midwives work: the home, the hospital, and where available, the freestanding birthing centre. It is important to understand that research repeatedly supports the safety of home and birthing centre births when women are followed through their pregnancies and attended at the birth by a qualified practitioner. Midwives bring to home births considerable necessary equipment and are trained to manage most emergencies at home or until the woman or baby can be safely transferred to the hospital. As well, it is essential to emphasize that midwives now have hospital privileges in most provinces and can be primary caregivers for women in this setting. The model is embedded within the provincial health care systems and midwives have links with the medical profession and means of consulting and transferring care to physicians if necessary.

I wish to acknowledge that women want a variety of different things around their births: some wish medication, some wish unmedicated births; some wish to give birth in a level three hospital with obstetrical emergency care close at hand, others would prefer to give birth at home. Some women have the possibility and wish to make choices around their births and others do not have a range of options open to them or have a particular wish to make choices around their pregnancies and births. What seems to be clear from research done around women’s experiences of their births is that most would like to know their caregiver(s) and would like their caregiver(s) to know them. They want to be treated kindly with respect and have time to ask questions. They also want to choose caregivers in whom they believe will provide the safest care for them and their babies. It seems essential that, where possible, women be offered the choice of caregiver whether it be midwife, family physician or obstetrician.

For more information about Canadian midwives, please visit the Canadian Association of Midwives