Paul Bickford
Northern News Services

Yellowknife (May 27/02) - When the word "midwifery" is spoken in the NWT, it's not long before another word follows -- "legislation."

Midwives Lesley Paulette, left, and Gisela Becker work out of their prenatal clinic in Fort Smith. - Paul Bickford/NNSL photo

It's as if the two words were born twins.

The issues and controversy surrounding the practice of midwifery in the NWT all centre on the lack of legislation. Without a legal framework, midwives are not recognized as part of the medical system.

They can't get insurance, they aren't funded, and doctors are hesitant to work with them for fear of liability risks.

But according to the territorial government that is all about to change.

Window of opportunity

Mark Cleveland, the deputy minister of health and social services, says midwifery legislation will be introduced next spring.

"That's certainly our plan to proceed with drafting and tabling of legislation," Cleveland says, noting it will have to be brought forward by spring in order to be passed by this assembly.

However, Lesley Paulette and Gisela Becker, two Fort Smith midwives who have pushed the agenda for legislation, are hopeful, but not confident the new law can be passed before the next election.

"There's a window of opportunity," Paulette says.

Becker adds, "I really hope it will happen, but on the other hand, there's a very good chance it won't happen."

Paulette says a draft discussion paper on midwifery from the Department of Health is a positive step.

She is also looking forward to June's round-table discussion in Yellowknife, which will bring together various stakeholders, such as midwives, physicians and government officials.

Cleveland says the government is working with a number of parties to prepare the groundwork for a new law, and midwifery legislation in the provinces will be examined.

He describes the process as research and development.

Driving the process

The deputy minister recognizes the role the two Fort Smith midwives play in driving the process: "I think they certainly have reinforced the importance of addressing the issue."

When asked about the role Fort Smith is playing in stirring the pot to get things moving, the midwives both laugh.

"It's the hotbed of midwifery activism," quips Paulette.

Most recently, Becker was involved in controversy when a Fort Smith doctor refused to deal with her despite the wishes of a pregnant woman.

Becker and Paulette both say they understand physicians' concerns.

However, Paulette notes, "I'm not so sure that it has a basis in real risks."

They want better communication, and say that would be easier with a clear framework under which to practise.

Cleveland says the recent Fort Smith issues are under discussion. "I believe they're working through them."

Protocol progress

Those discussions were recently assisted by Dr. Andre Corriveau, the NWT's chief medical officer.

Corriveau has met with the Fort Smith Health and Social Services Board, physicians and the midwives, and says he believes progress was made in creating protocols.

"For some physicians, midwifery is an unknown quantity," he says, adding the lack of legislation exacerbates the concerns.

While he says legislation is necessary, Corriveau says, in the meantime, a collaborative approach can outline scopes of practice.

As an example, he points to Rankin Inlet, where midwives practise under the Nunavut Department of Health and Social Services, despite a similar lack of legislation in the eastern territory.

Corriveau says the NWT has provincial legislation on which to draw, and "we don't have to reinvent the wheel."

Midwifery is currently legislated in Alberta, B.C., Ontario, Manitoba and Quebec.

Both Fort Smith midwives are registered and insured in Alberta.

Corriveau says that, in order to introduce community birthing in the NWT in a sustainable fashion, midwifery will need to be incorporated into the system, partly because of the shortage of physicians.

No funding

The practice of midwifery is also not funded in the NWT. The two Fort Smith midwives depend on donations or provide the service for free, Becker says. She and Paulette estimate that, in Fort Smith, 50 to 75 per cent of the approximately 40 pregnant women a year make use of their services.

"That indicates there is a need," Becker says.

The two midwives also believe there is a demand for midwifery services throughout the NWT.

Paulette stresses they are not doing anything illegal in providing the service.

"We're in an 'alegal' jurisdiction. There are no laws on the books."

As president of the Midwives Association of the NWT and Nunavut, Becker made a presentation on May 16 to the Commission on the Future of Health Care in Canada during its stop in Yellowknife.

She noted most women in the NWT and Nunavut are sent to larger centres to deliver their babies under the care of a physician, often leaving their families and incurring additional cost.

She also pointed out there is no statistical difference in mortality rates between medical and midwifery care.