MIDWIFERY IN CANADA, THE MESS WE’RE IN

Many people are confused about why Canadian birth attendants are prosecuted for the most minor actions. . . . calling herself a “midwife”, doing a vaginal examination at a woman’s request or with permission, advising a woman about how to eat for her unborn baby, etc.

Let me tell you how we got into the mess we’re in. Yes, it is a mess. Hundreds of thousands of dollars spent on legal actions, clients left upset and confused, hospital workers unclear about the legalities in their area, each province of Canada having a different wording in their Act, midwives mistrusting doulas and each other. It’s a climate of fear and turmoil that isn’t getting better after more than 20 years of legislating midwifery. (Ontario regulated in 1993, B.C. followed in 1998)

The first problem is that legislators tried to make laws to cover a life event that is natural and one that a woman can do all by herself, if she chooses. Birth is a normal life process. We don’t usually legislate who can be with an adult when they are in their own home. What can you make illegal about a woman having a baby and choosing someone to be with her? Well, you can make it illegal for that someone to charge money for being there. That doesn’t really fit with a concern for the well-being of the woman/baby. If a birth attendant is really wealthy can they go to help birthing women with no fear of the law? If the pregnant woman wants to donate money to her helper’s children, is that illegal? You can see it gets very tangled. The laws have been twisted and turned to try to make them less ridiculous as time goes by but no province has succeeded in coming up with wording that makes common sense.

Then, the law makers thought, “okay let’s make it illegal to do clinical acts like vaginal exams, injections, blood tests, etc.” Trouble with that is a) it is almost impossible to police these activities when they happen in a private home and, b) women allow their partners to perform vaginal exams all the time. Many massage therapists do pelvic therapy with vaginal exams, naturopaths, nurses, etc. so how does it help to say that one particular group cannot do vaginal exams? So, by saying that only a member of a midwifery disciplinary body may do a pelvic exam, things get almost laughable. Since any 16 year old boy can figure out how to do it, it’s hardly an act that needs 4 years of training. Many lay people have to give injections to their children/loved ones, learning how to draw blood takes about 2 hours, all these things are done by a myriad of workers in the community. It is grasping at straws to make these minor clinical acts a basis for a prosecution.
FirstNationsMW

The original intention of seeking licensure started with midwives wanting to be paid under the National Medical insurance plan and to be protected from prosecution/persecution from the giant medical monopoly. That intent backfired right away due to the medical profession. Instead of embracing the midwives as colleagues, they began advising the clients of registered midwives to sue their midwife. There have been lawsuits against registered midwives here in B.C. where millions of dollars have been paid out to families. If a child has any type of neurological damage, the family physician advises the parents that “ the money won’t come out of your midwife’s pocket. That’s why they carry insurance. The insurance is there and you don’t know if your child will need special care that’s not covered by the National Medical insurance plan when he/she gets older. You’d better sue now.” Of course, they would never say that if the care provider was a physician. You can guess what happened then. The insurance rates for midwives right across the country went through the roof. Different provinces have different schemes for covering the midwives but the bottom line is that the government really doesn’t want more midwives because each midwife has to be subsidized for about $30,000 per year in order to provide insurance for her practice. If the midwives had to pay it all, they would be out of business immediately. The government also doesn’t want to give them a raise which leads to a great deal of bitterness on the part of the registered midwives.

Registered midwives are between a rock and a hard spot. They want to follow their dream and have happy, contented clients BUT they rely on the physicians to give them hospital privileges and, if they don’t toe the line of what the doctors wish them to do, they can lose those privileges or even lose their registration.

So, when you’re wondering what’s going on with registered-midwife-generated court cases to pound unregistered birth attendants out of business in Canada, this is some of the background. Because the numbers of registered midwives is low AND the midwives are so limited by the medical profession, there exists an alternative birth attendant market. There are a number of women throughout the country who still go out to help at home births without a blessing from the medical profession/government. They simply don’t want to work in that space between the rock and the hard spot.

CHARGES AGAINST BIRTH ATTENDANT, LISA KUSCH

Lisa Kusch Case in Saskatchewan, Canada

When a birth worker is charged with an offense in Canada, she receives legal advice not to discuss the case and not to speak with the clients involved. This makes things very difficult because she must raise funds to cover expensive legal bills and she can’t campaign on her own because of these restrictions.
I have asked for facts from different sources and submit the following information for those who are helping with the funding and care about my friend, Lisa Kusch.

Lisa in 2015

Lisa in 2015


In October 2016 Lisa was charged, as follows:
“It is alleged that between the 29th day of October 2014 and the 29th day of November, 2014 in Saskatoon Saskatchewan, Lisa Kusch “ DID ENGAGE IN THE BUSINESS OR PRACTICE OF MIDWIFERY, WHILE UNAUTHORIZED TO DO SO, CONTARY TO SECTION 23(2) OF THE MIDWIFERY ACT” (see below for the wording of that section of the Act).
That’s it. There are no specific details of what Lisa did or did not do. It seems to me that this is an overly broad and vague accusation. The document with the allegation was accompanied by emailed complaints filed by the birthing woman and the attendant at the birth (a doula/friend of the woman who accompanied her when she transported to the hospital).

Some of the information I have gathered which is to the best of my knowledge:
1. Lisa was not present when the baby was born.
2. Lisa is not a Registered Midwife and doesn’t represent herself as a Registered Midwife. That has been agreed upon by all parties and she is not accused or charged for this.
3. The woman was having her first baby and transferred to hospital for pain management. I am told that the baby was delivered by non-emergency c-section, at the mother’s request. The medical reason given was failure to progress.
4. Mother and baby were discharged from hospital on a normal schedule.
5. Lisa is accused in the complaints of causing poor outcomes and delayed recovery, due to excess blood loss during the surgery.

If Lisa is found guilty of a summary offense the result will be a fine of up to $4000. This is not a criminal case and it is not a civil case. The burden of proof is on the Crown to prove that the defendant practiced unauthorized practices according to the Midwifery Act of Saskatchewan. If one reads the applicable section of the act quoted in the charge above, it is vague in its definitions.
This case will set a precedent as it is the first in Saskatchewan and will have national implications.
The trial date is now set for October 24, 2017.

Start of Section 23 (2) No person shall engage in the business or practice of performing any of the authorizedpractices described in subsection (1) with respect to another individual unless:
(a) the person is a member who is authorized by his or her license to perform
that practice;
(b) the person is authorized pursuant to another Act to perform that practice;
or
(c) the activity is one of daily living and is performed by the individual or by
a person on the individual’s behalf. (end of section)

I submit the above to help people see the bones of this complaint and action against Lisa Kusch. Thanks for reading. I will update/edit as more info comes to light. Gloria Lemay, July 12, 2017

Some people have asked if they can send money for Lisa’s fund by bank transfer so I’ve set up a separate email and bank account for that purpose. The email address is lisakuschfund@gmail.com I’ll post periodic messages on the GoFundMe page about the total that comes in via bank transfer.
Lisa Kusch

The GoFundMe page to donate to the legal fund is at https://www.gofundme.com/lisakusch

Preparing for a Home Birth

Home Birth Supply List

Please let me know well in advance if you are unable to find any item on the list. Collect all supplies and place them into a box. Place the box in an easily accessible place. Please tell the midwives where the supplies are kept when they arrive for the birth.

 24 flat incontinent pads to use under Mom’s bottom (22” x 24”)
 1 box of 4”x4” gauze squares
 2 boxes of Super Kotex pads (overnight)
 1 box or bag of salt (cheap, for stained linens)
 1 450 ml bottle of Hydrogen Peroxide (for removing stains from carpets, etc.)
 1 small bottle of bleach or Sudsy Ammonia
 1 100 ml bottle of Witch Hazel
 1 sealed small bottle of Olive Oil for perineal massage, baby’s bum
 1 bag of “pure” cotton balls
 2 large green garbage bags
 2 Plastic sheets (shower curtain liners work)
 1 flashlight with extra batteries
 1 plug-in room heater (if needed)
 1 hot water bottle
 1 nail brush
 1 tea strainer
 Womanly Art of Breastfeeding (book)

Nice Extras:
Bath pillow, candles, ice cubes, popsicles, plant mister, music, camera/film, tapes, thermometer, massage cream, heating pad, small Fleet Enema (if you get constipated a lot in pregnancy), reusable cotton menstrual pads.

Preparing Your Home:
Make up 5 casserole dishes to get you through the first days after birth and freeze them. Put a plastic sheet on your bed in the last week of pregnancy in case your waters break. Dust and clean the bedroom. Clean the toilet and bathtub. Clear off the top of a chest of drawers or other surface for us to put our instruments on. Make arrangements to have your pets out of the house during the birth.

Sterile Linens:
 6 face cloths
 6 bath towels
 2 bed sheets
 2 cotton cloth diapers
 6 receiving (flannel) blankets for baby
 1 undershirt and nightie/sleeper for baby

Put clean linens in HOT dryer for one half hour. During the last 10 minutes throw in 3 brown paper grocery bags and heat them through. When dryer finishes, fold the hot linens with clean hands and put them in hot bags. Seal them with staples or tape and label the outside. Store in a dry place. You do not need to use your best linens…clean is our main concern.

Electrolyte Balanced Drink (Labour-Ade):
1/3 cup lemon juice
1/3 cup honey or maple syrup
1/4 tsp salt
1 crushed calcium tablet (or 1/4 tsp calcium powder)
enough water to make 1 quart

Mix all ingredients together- use warm water to help dissolve the honey and calcium, and then chill. You can also make ice cubes. Buy enough ingredients to make 4 quarts. This is a delicious drink for after the birth as well. *After the baby is born you can add 1/4 tsp. cream of tartar to this drink to assist with peeing after the birth.

Your Newborn Baby—What’s Normal?

    Parents’ Guide to the Newborn

Keep your caregiver informed of any concerns about your baby.
Phone number of dr., public health nurse, midwife, or other provider Name_______________________Phone_____________________

Your baby’s breathing

Noises such as snuffles, grunts, wheezes, etc are not a concern by themselves. Babies can be noisy breathers. They have small amounts of mucous in their airways from the birth process and they are adjusting to air breathing. It is normal for the breathing to be irregular—sometimes rapid and then followed by slow, deep breathing. When your baby cries vigorously, he/she will become redder in the face and take deep, gasping breaths. This is normal.

Concerns about breathing to notify your caregiver about are:

1. Chest retractions–if your baby draws the chest wall in noticeably when breathing and you can see the outline of the breast bone with every breath.

2. Prolonged rapid breathing–the rate of breathing in a healthy calm newborn should be about 30 to 40 breaths per minute. If the baby is doing a panting breathing when calm (60 or more breaths per minute) for more than 15 minutes, have your caregiver check.

3. If your baby seems to have worrisome breathing and blueness around the mouth, call your caregiver.

FEEDING Within 8 hours of birth, the baby should be waking to feed every two hours and latching on to the breast well. Demanding to be fed is a very good sign of health in a newborn. Your baby needs only what is in the breast, do not feed water. If baby seems lethargic and doesn’t wake to feed for 4 hours, call your caregiver immediately. This behavior might mean the baby has a serious infection.

COLOUR A small amount of blueness and coolness in the extremities (hands and feet) is normal. Some mottling of the chest and tummy is normal. Many parents are alarmed by the baby’s whole body going dark red like a strawberry, this is a normal result of changing blood circulation in the newborn. Generalized blue or gray colouring (rare) would be alarming.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

TEMPERATURE Only take your baby’s temperature under the armpit. Digital thermometers can be purchased for about $12 at the pharmacy. If the temperature falls below 36.1 degrees Celsius (97 F) or goes above 37.2 degrees Celsius (99F), look to see if you have bundled the baby too warmly or if the baby needs more covering. Adjust the baby’s garments and recheck the temperature in 15 minutes. Call your caretaker if abnormal temperatures persist. The usual rule of thumb for baby covering is to look at what the adults are wearing and then add one more layer for the baby. The baby being skin to skin with the mother is a good way to help the baby have a normal temperature and breathing rate.

URINE The baby may only have one wet diaper per day for the first two days. Once the breast milk is in, the baby should have at least 6 very soaked diapers in 24 hours. Urine should be colourless. Some babies have crystals in their urine (orange staining that looks like face makeup) and this is not a concern in the first 3 days. After the third day, that orange staining can be a sign that the baby is dehydrated. Increase the time at the breast and advise your caregiver. Little girls may have a spot of blood in their diaper which is their first menstrual blood, this is normal. By the fourth day, the baby should have at least 6 very wet diapers per day (the diaper will feel heavy in your hand).

BOWEL MOVEMENTS In the first 24 hours of life, the baby will pass meconium (blackish, tarry stools). Next, the stools will be brownish, greenish and quite soft. Once the milk is fully in (around day 3 of life) the baby’s stools are the colour and consistency of yellow mustard. The baby should have two poops the size of a loonie (silver dollar) as a minimum every day. A well fed baby usually has much more than the minimum.

UMBILICAL CORD Fold diapers down away from the drying umbilical stump. The cord will be dry and blackened within 24 hours and the clamp can be removed. The stump usually rots off by 5 to 10 days after the birth. Don’t put peroxide or alcohol on the cord. It heals best if left alone. Because it is rotting flesh, there is usually a foul odor when it is ready to fall off and it can be quite goo-ey looking. If there is redness on the abdominal skin surrounding the belly button area, notify your caregiver.

EYES The policy in hospitals is to treat the baby’s eyes with an antibiotic cream called “Erythromicin”. If you do not want your baby to receive this antibiotic, let your caretaker know in advance and sign a waiver. Newborns can have plugged tear ducts which cause discharge to accumulate in their eyes. Bring any discharge concerns to the attention of your caregiver.

INTACT PENIS Keeping your son’s penis intact is now the recommended policy of physicians’ groups. There is no special cleaning that needs to be done. Simply bathe your baby in a warm bath and leave the foreskin alone. The foreskin is attached to the glans in babies (much like the fingernail is attached to the finger) and the separation process may take years to complete. Only the boy should retract his own foreskin, this should not be done by parents or medical professionals. For more info on caring for your intact son, there is a handy free brochure at this link http://www.nocirc.org/publish/pamphlet4.html

JAUNDICE Yellowing of the skin of the newborn in the first 24 hours of life is unusual and should be called to the attention of your caregiver.
After Day 2, some yellowing is normal. Usually the face and chest are the most yellow places on the body. The baby may be sleepier than normal with jaundice and you may have to wake the baby to feed every two hours. It’s important that the baby remains well hydrated in order to get rid of the yellow cells from the body. Let your caregiver know if you are having trouble waking/feeding the baby or if the yellowness extends out to the hands and feet.

Slightly jaundiced newborn

Slightly jaundiced newborn

Gloria Lemay, Vancouver, BC
March 2016

Grand Multipara Birth

From www.nzdl.org

From www.nzdl.org

This is an online conversation that I had with a grand multip (woman who has given birth more than 5 times). There are special things about birth after the fifth baby. . . for instance, sometimes the process can be stop and start for days and, then, suddenly. . . here’s the baby. There is nothing wrong with that way of birthing but, because large families are relatively rare, many practitioners lose faith and patience and brand the woman as “failure to progress”.

Another unique thing about women carrying a fifth or more baby is that they are prone to what midwives call the “blue right leg syndrome”. It can be alarming to see how blue the right leg becomes in pregnancy but, then, the baby is out and the woman’s right leg looks just fine again. I like to read things by the midwives in the USA who serve religious groups with big families. Lots of little anecdotes like that.

CORRESPONDENCE BETWEEN GLORIA AND CAROLINE

Hi Gloria,
I am wondering if you could answer a couple things for me.
I was reading your post about the 30 Minute Third Stage, and saw your comment about the anti-bleed tea. I’m curious to know more about this.
I understood that shepherd’s purse was not to be used until after the placenta was delivered, and that it was dangerous to use it before.
I see that one of the ingredients for your anti-bleed tea is shepherd’s purse. Can you share with me how it differs in the tea, as opposed to using the tincture? Also, is this safe to use as a grand multip? This is my 10th baby, 14th pregnancy.
I tend to bleed a fair bit with my births, and I am trying to be prepared this time, (due in August) and read and research things that I could/should try to have on hand, especially in case my attendant doesn’t make it here on time. I tend to go quickly, and feel a strong need to be prepared this time.
Thank you for any input you are willing to share (smile emoticon). Caroline

TUES 22:35
Hi Caroline, One of the things with grand multips that really helps prevent bleeding is going for a 1/2 hour brisk walk. One of my clients found some research on it and it really seems to work. I don’t know why. As far as the shepherd’s purse, no one can really do studies on these herbs and their use after a birth. We worry more about after pains with grand multips. Therefore we give a cramp bark /cinnamon tea. A couple of things that I’ve seen lately that interest me for the after pains are 1. Increasing magnesium supplementation after the birth. 2. Emptying the bladder more often than you think you need to. Just get up and pee if it’s been a while and don’t wait till you feel like pee’ing. Apparently these 2 things are very helpful for cramps. Thank you for writing. I’d love you to have a smooth, relaxed birth. Gloria
06:07

Thank you so very much for your time!!
These are some very interesting points.

I’m curious for a little more information on the brisk walk. Is this something your recommend in labor? Or for the days leading up to birth?

I feel so much peace about our upcoming birth. Much more so than I’ve felt with any of the others. But I also am loving to learn as much as I can about birth as a whole, and things that could be useful for my own as well.
Thank you again. Caroline

10:30
You’re very welcome, Caroline. I mean a walking program starting NOW. I never ask women to walk when they are in the birth process. I’m afraid they will hit me! ha ha. You’ll know what you want to do when having the baby, it’s the preparation that’s important. By a walk I mean a brisk walk with no kids, no purse, flat shoes and really walking as fast as you can. Gloria

Gloria, Thank you! I will start doing that today. ?

I am soaking up as much information as I can.

I also have to say that I love following your page and reading on your site. So much information that has been so useful.
Thank you for everything you do!!
Makes me wish I was in Canada and could meet you! Caroline

That’s very sweet of you. You are exactly the woman I am writing for, so many people just can’t “get” what I’m trying to communicate.
Gloria

I am loving the learning! I have been trying to dig as deep as I can, and find as many different ideas and perspectives as I can. I’m always thrilled when I find new perspective that makes sense!
Will you be offering your online class again in the future? I would be very interested in taking part, if you do.
Caroline

Added: Another tip I will give to grand multips. When you have lots of older children, they ALL want to hold the new baby. This gets to be a competition and a struggle and it could be a reason why the mother might bleed too much. Explain to the entire family like this: “It’s very important that Mommy has the baby on her skin for the first day of the baby’s life. That helps Mommy’s body to change over from being pregnant to being a nursing mother. If we want Mommy to stay at home and be healthy, we are ALL going to wait until the baby is 24 hours old before we take turns holding the baby.” In most families, the kids really understand this and they don’t mind so much not holding the baby as long as no one else is either.

Podcast available for download

I had a great time being interviewed by Alain Desaulniers, DC, recently. Enjoy this podcast. Love, Gloria

Thanks so much for sharing about your AWESOME birth story and for your willingness to share so openly and authentically. I hope that millions are transformed through your words and message! I look forward to connecting with you soon! You rock!
I would be honoured if you would share with your circle of influence!

Your Show’s link:
http://everydayrevolutions.net/022glorialemay/
Main Website Link:
http://EverydayRevolutions.net
iTunes LINK:
http://EverydayRevolutions.net/iTunesRevolution
Back up iTunes LINK:
https://itunes.apple.com/ca/podcast/everyday-revolutions/id985104432
Stitcher Link:
http://www.stitcher.com/podcast/everyday-revolutions
Soundcloud Link:
https://soundcloud.com/everyday-revolutions
The Everyday Revolutions Facebook Fan Page:
https://www.facebook.com/BeTheEverydayRevolution
Lastly, as Everyday Revolutions is quickly becoming a renowned podcast and resource for health, inspiration and motivation for living an awesome life:
• 40,000+ Downloads in just the first few months
• Ranked as high as #5 in iTunes Health, #1 in iTunes Fitness & Nutrition, #2 in iTunes New & Noteworthy, #77 in iTunes Overall.

Thank you for giving back,
Alain

Dr. Alain Desaulniers

Family Chiropractor, Everyday Revolutions Podcast Host, Educator, Keynote Speaker everydayrevs

Subscribe to the Everyday Revolutions podcast on iTunes, Sticher Radio or Soundcloud

Placenta Bowl, a family tradition

Lightened photo shows detail on the underside of the bowl.

Lightened photo shows detail on the underside of the bowl.

Copyright Gloria Lemay 2014

The birth of a baby is a time to really consider what family traditions should be kept and what family traditions should be discarded. It can be a time to get creative and design rituals that truly nourish the heart. This wooden placenta bowl was commissioned by a family and carved by a B.C. artist. It is now being used at the second generation of homeborn babies in the family and will be passed on for years to come.

Shared with the kind permission of the family.

Checking Your Own Cervix

How to Check Your Own Cervix- “it’s not rocket science”

“I think it’s a good and empowering thing for a woman to check her own cervix for dilation. This is not rocket science, and you hardly need a medical degree or years of training to do it. Your vagina is a lot like your nose- other people may do harm if they put fingers or instruments up there but you have a greater sensitivity and will not do yourself any harm. Clean your hands well and make sure your fingernails are trimmed and rounded.

“The best way to do it when hugely pregnant is to sit on the toilet with one foot on the floor and one up on the seat of the toilet (or if that yoga is too difficult, put one foot up on the bathtub or a stool with your knee bent).

toilet Put two fingers in and go back towards your bum. The cervix in a pregnant woman feels like your lips puckered up into a kiss. On a non-pregnant woman it feels like the end of your nose. When it is dilating, one finger slips into the middle of the cervix easily (just like you could slide your finger into your mouth easily if you are puckered up for a kiss). As the dilation progresses the inside of that hole becomes more like a taught elastic band and by 5 cms dilated (5 fingerwidths) it is a perfect rubbery circle like one of those Mason jar rings that you use for canning, and about that thick.

“What’s in the centre of that opening space is the membranes (bag of waters) that are covering the baby’s head and feel like a latex balloon filled with water. If you push on them a bit you’ll feel the baby’s head like a hard ball (as in baseball). If the waters have released you’ll feel the babe’s head directly.

“It is time for women to take back ownership of their bodies.”
-Gloria Lemay, Vancouver, BC

http://www.gentlebirth.org/archives/birth.html#Self-Checking

    Update

One birthing woman who checked her own cervix described it like this: “I could feel my bag of water bulging down and then later the baby’s head once the waters broke- so cool.”
“How did I do it? I just reached up in all the way to the back and felt. It’s sort of awkward/difficult to reach but if you are familiar with what your cervix normally feels like, sort of like the tip of your nose, it gets shorter and stretchy. I felt it at like maybe 2 cm, about 6, which is when I could feel the bag, and then when it was time for baby to come. When the contractions were getting super intense I pushed a bit and that was enough to break my waters. Babe came shortly after.”
(shared with permission) 2014