NORTHWEST TERRITORIES
Mothers are asking why the Department of Health and Social Services is again hosting community consultations on midwifery services, five years after a report outlined how those services should be established in communities.

Johanna Tiemessen at a midwifery support rally in front of legislative assembly Feb. 22, 2013. Tiemessen says more consultations by the GNWT aren't needed. - NNSL file photo

"I understand to develop a sustainable program, a strong plan needs to be in place, but we seem to be reinventing the wheel," said Johanna Tiemessen, a midwifery advocate and trained doula in Yellowknife.

"It all comes down to personal choice for the woman, for the family, but right now we do not have a choice and we continue to not have a choice until something changes, and apparently that change is now being consulted on from the territorial model."

A territorial model was one of three options for midwifery services in the territory, which are outlined in a report published by DPRA Consultants in 2012.

The report looked at community-based, regional and territorial models of midwifery care and determined that the community-based model was best, both in terms of services and cost savings.

"Based on the three models presented in this report (community, regional and territorial) and the assessment criteria identified (cost and health/social outcomes), we recommend the community-based model of midwifery care for consideration by the GNWT's Department of Health and Social Services," the report stated.

It outlined that communities with 25 births per year could sustain midwifery programs, employing two midwives for every 50 births. Behchoko, Inuvik, Hay River and Yellowknife were identified as meeting those demands.

But the department is still looking at other ways of implementing the program, including a territorial model, said Kim Riles, assistant deputy minister of health programs.

"Certainly moving forward with a territorial midwifery program has been one of the focuses that we've carried forward for midwifery expansion since the 2012 report," she said. "This is really a next step of validating whether that's an approach that meets the needs of our communities and our system and looking toward how that could be a fit."

The community consultations, which are scheduled to run throughout March, will help inform that decision, Riles said.

In the 2012 report, the territorial model would require eight midwives located in Yellowknife.

Right now, there are midwifery programs in Fort Smith and Hay River, both of which have two midwives.

When asked if adopting the territorial model would mean midwifery services would only be available in Yellowknife, Fort Smith and Hay River, Riles said it was too early to tell.

"We don't know exactly what the model will look like," she said. "Whether that, in fact, ends up being the model that . . . will work and will actually improve and enhance maternity care services is yet to be determined."

While it formerly had a community-based midwifery program, Yellowknife's program was shut down in 2011 "pending the recommendations of this review," the report stated.

But it didn't start up again in time for Yellowknife resident Lindsay Arseneau, who paid more than $3,000 in travel and other expenses to access midwifery care in Hay River when she was pregnant with her second child last year.

"It was a ton of planning," she said.

Arseneau was living in Iqaluit when she gave birth to her first child three years earlier. She said she believes her labour was prolonged because she didn't feel comfortable in the hospital. When she became pregnant with her second child, she knew she wanted midwives.

While women in Hay River have a choice about whether to use the community's midwives or travel to doctors in Yellowknife, that option isn't available to women in the city who want to use midwives elsewhere, Arseneau said.

Instead, Arseneau paid her expenses out of pocket. She and her family moved to Hay River Suites two weeks before her daughter was born on April 3 and Arseneau stayed an additional week for follow-up care.

She said she knows her decision was expensive but she made the right choice.

"I felt so comfortable and confident," she said.

Part of that confidence came from knowing her midwifery team would be there when she went into labour, information that simply isn't available in a hospital setting.

"You don't know which physicians you're going to have," she said. "There are lots of physicians I love here in Yellowknife, but there's no guarantee when you walk in the door."

Thea Campbell agreed. She had a baby in Yellowknife last year and said while she knows the care she received was good, she would have much preferred a midwife.

"Here, I saw probably about 13 different doctors throughout my pregnancy," she said. "That's a little bit disconcerting when you're doing something for the first time that you've never done that's so big, whereas with a midwife you would have a very small team, perhaps the same midwife throughout your whole pregnancy."

Wanting midwives isn't a reflection of the quality of hospital care in the territory but about giving women a choice about how best to give birth, Tiemessen said.

"We have great doctors at the hospital but babies shouldn't necessarily be born in the hospital," she said. "Birth should be looked at as natural and normal until something goes wrong, not the other way around."

The women interviewed for this story said they were frustrated with the length of time it's taken for the program to get off the ground.

"The word on the street right now is why are we putting money continually into consultation when we could just hire some midwives?" Tiemessen said.

Riles said there had been delays for about a year until two midwifery consultants were hired last year.

"We did go through a period where we had difficulty staffing the planning positions for midwifery at the department of health, however we were successful in recruiting for those positions a little over a year ago," she said.

"Since then there's been an enormous amount of background planning that's taken place."

She added that the department encourages anyone with concerns to participate in the community consultations.

In a follow up e-mail to News/North, Riles said a finalized program won't be ready until 2018-2019.

"2018-19 is the earliest we could possibly see a program begin to roll out, contingent of course on approval of funding," the e-mail stated.

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