B.C. Registered Midwives on slippery slope

Instead of receiving a raise in pay, B.C. midwives recently were allowed to increase their client load to 60 births per year from the previous ceiling of 40.  At that point, some B.C. registered midwives began taking photographs of their clients so that they would be able to recognize their faces.  We are certainly sliding a long way from the promise of one on one individualized care for pregnant women with extra time in prenatal visits to develop a relationship of trust. 

Today, we received the following alarming press release which indicates that midwives are slipping more rapidly into the arms of the very system they once opposed. 


VICTORIA – B.C. is supporting health professionals and creating more choice for patients by enhancing the scope of practice for midwives, naturopathic physicians and registered nurses, Health Services Minister George Abbott announced today.
             “Expanding the role of midwives, registered nurses and naturopathic physicians allows B.C.’s health system to offer more options for patients,” said Abbott. “British Columbians made it clear during the Conversation on Health that they want increased choice and better access to health services and today we are meeting our 2008 throne speech commitment to expand the scope of practice for these professions.”
             Under the new regulations, midwives will be authorized to deliver a broader range of services to new and expectant mothers. These services include initiating induction and augmentation of labour, use of acupuncture for pain relief in labour and assisting medical doctors with C-sections. These specialized practices will be performed by midwives who have obtained additional education and certification.
             “Enhancing the scope of practice for midwives recognizes the full range of training and expertise of this profession and supports our goal of ensuring safe and timely care for our clients,” said Terry Lyn Evans, president of the College of Midwives of B.C. “The new regulations are great news for the midwifery profession and for the new and expectant moms who choose to use the services of a midwife.”
            There are close to 140 midwives practising in British Columbia and midwifery has been a regulated health profession in B.C. since 1998.
             The enhanced scope of practice for naturopathic physicians means practitioners with additional training will be able to prescribe medication as appropriate to their primary care practices.
             To protect patient safety, the regulations require naturopathic physicians to have successfully completed a certification course before administering, prescribing or dispensing prescription medication. Additionally, the College of Naturopathic Physicians of B.C. will receive access to B.C.’s PharmaNet database system so that it can monitor its members’ prescribing patterns.  The College will also establish standards, limits and conditions for prescribing based on the recommendations of an inter-professional committee that includes medical doctors, pharmacists and a Ministry of Health Services representative.
             “The scope of practice legislation for naturopathic physicians has been unchanged in B.C. for more than 50 years,” said Dr. Lorne Swetlikoff, naturopathic physician and board chair of the College of Naturopathic Physicians of British Columbia. “This move recognizes the current education and skills of naturopathic physicians and allows us to fully support the needs of our patients.”
             There are over 300 registered naturopathic physicians in B.C. and naturopathic medicine has been a regulated health profession in B.C. since 1936.
             With the enhanced scope of practice for the nursing profession, registered nurses will now be authorized to independently provide a broader range of health services including suturing, tuberculosis screening and managing labour in hospital when the primary care provider is absent. Registered nurses working triage will now also be able to immediately order diagnostic ultrasounds and X-rays. Additionally, registered nurses will be able to dispense or administer prescription medications in urgent situations including severe allergic reaction, drug overdose, post-partum bleeding and for communicable disease prevention and management.
             “An enhanced scope of practice for registered nurses recognizes the key role that they play in B.C.’s health-care system,” said Val Cartmel, president of the College of Registered Nurses of B.C. “These changes will increase efficiency and choice for patients while registered nurses and nurse practitioners will continue to work closely with other health-care professions to provide safe, quality care to patients.”
             There are more than 34,500 registered nurses in the province and registered nurses have been regulated in B.C. since 1918.
             Over the past year, B.C. has made a number of regulatory changes to increase the accountability and transparency of B.C.’s health system and support health professionals. In order to streamline the regulatory process, the Province repealed a number of individual pieces of health legislation and 20 health professions, regulated by 19 professional colleges, have now transitioned under the Health Professions Act. Additionally, the Health Professions Review Board, which has the power to review the timeliness and outcome of health regulatory college decisions, began receiving applications for review in March 2009.
             For more information on the regulation on health professions on B.C., please visit www.health.gov.bc.ca/leg/.

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It was Ivan Illich who said “The death knell of a viable underground organization is legalization.”

Here’s what I wrote to the government officials in response to today’s press release:

Dear Sirs,  one of the biggest problems we have in obstetrics in the Province of B.C. is a high rate of inducing birth with the resulting increase in cesarean sections.  Allowing midwives to induce births is not a way to expand midwifery services.  Induction of birth is a medical event and has nothing to do with natural, normal birth.  Getting some midwives attending home births in the Sea to Sky corridor would be a way to expand midwifery services.  The doctors at the Squamish General Hospital are obstructing the efforts of consumers to get midwives working in that area.  Let’s expand midwifery by keeping birth natural and normal and leaving the medical interventions to medical people.
Gloria Lemay, Vancouver BC
1997 Nominee for YWCA Woman of Distinction Award
2002 Recipient of Choices “Women’s Voice Award”

11 thoughts on “B.C. Registered Midwives on slippery slope

  1. You are so right Gloria. Midwives need rights in normal birth such as VBAC, breech and twins. Not in more medicalization. Let the doctors do the doctor things and let the midwives protect, encourage and enhance normal birth with their love, dedication and skills.

  2. Right, so the the midwife ‘initiates’ an induction or augmentation of labor, and then…. transfers to the hospital?
    I do think though, that this can be used in our favor. If the midwife is allowed to initiate induction, she can also decide not to and thus keep people off a woman’s back, or well, belly in this case. He. I also think it is good that with this new regulation, a midwife can stay with a woman who ends up with a cesarian. This can mean the world to the mom, I am sure.
    Maybe I am misunderstanding?
    Either way, I am not in favor of any kind of regulation of midwives, because the repercussion of this I think, misrepresent what midwifery is about, but where there is a system, the system can sometimes be worked I guess. I don’t know. I certainly agree that allowing midwives to do a few more medical interventions kind of misses the point of midwifery big time.

  3. I would like to add that the intent of our scope expansion is to allow registered midwives to care for more women and decrease the number of physician consults and intervention, especially in rural areas where there is a lack of maternity care providers. This ultimately provides more options to pregnant women and their babies.

    The rate of induction amongst registered midwives is very low and is always a woman’s choice. We discuss the available evidence and each woman’s individual situation as the option of induction may apply to her and her baby. The concept of informed choice and individualized care is very important in midwifery care and that fact sometimes gets overlooked. Registered Midwives love their work and the families they work with as do most people who work with birth. They put a large amount of effort into a very demanding job in order to expand the options available to women and this is also an important point to consider.

    Shannon Norberg, RM
    President – Midwives Association of BC

  4. I speak to many women who are ex-clients of B.C. Registered MW’s, Shannon, and I wish that it was true that you have low induction rates. Women have the “cocktail”, they have their membranes stripped, and they are sent for “consultations” with ob/gyns (thinly veiled intimidation sessions). It would be good to know what percentage of women who get to 41 weeks are induced in some way by their reg’d midwives. Do you have stats?

    The justification of why we can’t call reg’d mws on their aggressive behaviour towards birthing women is that they are so “loving” and they “work so hard”. It’s all b.s. Being loving and hard working isn’t a good enough reason to become a pimp for the medical profession. Being sincere doesn’t impress me either.

  5. “The concept of informed choice and individualized care is very important in midwifery care and that fact sometimes gets overlooked.”
    Is “informed choice” a truly broad spectrum education around birth and pregnancy or a biased representation of some facts?
    As far as individualized care goes ……….. with my second pregnancy I did not want to go back to the same registered midwives I had hired for my first. I decided I would meet with and interview a few different midwives I had heard good things about. At one established (registered) Midwifery Practice I called, the receptionist bluntly informed me that their midwives don’t do such interviews. They are too busy. You take what you get. So that’s where individualized care and empowerment through the pregnancy and the birth process starts? No thanks!

  6. I would like to say that I think induction almost never applies to a baby and although it my be appealing to the mother it is almost never in her best interest. I had OB/GYNs for my first pregnancy and BC Registered Midwives for my second and most of my third pregnancy. The concept of informed choice and individualized care MAY very well be important to registered midwives but I have to say that, based on my own experience you wouldn’t know it was important to them. In my life I put the things that are important to me FIRST!

    Megan Peters, mother of three

  7. I had a B.C. reg’d midwife with my second pregnancy. My membranes were stripped and I was induced. Not surprisingly, I experienced a hellish labor and finally a C-section. Midwives need more rights to practice natural birth, not expanded rights that bring them closer to a brutal, medicalized birth that so many women and babies suffer through.

    Faeron Lunsford

  8. Stripping of membranes and herbal brews are standard practice for midwives.
    As far as informed consent is concerned, it goes something like this: “I am the expert, I have informed you, now you consent”. Informed consent is meaningless.
    More midwives should have court orders against them, it is a blessing in disguise, they might then keep their hands out of woman’s vagina, meddling away.
    Increasing the numbers (to 60 per year)leads to larger practice – so they can cover for each other when everyone decides to birth a the same time – and midwives with too many births who transport just cause it is easier on them than a home birth.
    I hope they don’t ever register “rights” for TBA’s! or we will have to create a new name, once again.

    Jocelyne Mulder BWI CCE

  9. This is all about midwives and other mid-level providers wanting to play doctor without the prerequisite training. It’s a bad idea. I support midwives for in-hospital births for low-risk deliveries. I do not think they should be inducing labour or doing other medical procedures, since that is exactly what they are supposed to provide an alternative to.

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