by Avalon Moore
This past summer if you were in or around Montreal, or even if you were elsewhere in Canada, you may have heard about Heather Mattingsley, the Montreal mother who was asked by the province of Quebec to take a maternity test to prove that her newborn infant was in fact her own child. The government refused to issue a birth certificate until they felt certain of the newborn's parenthood. Heather Mattingsley's daughter was six months old by the time her existence was legally recognized by the province.
Why was Mattingsley's claim to her child so disputed by the government? It all came down to her choice of health care providers.
Like 25 % of women in Quebec, Heather Mattingsley wanted to have a midwife, and not a doctor, present at her child's birth. However, she found, as 80 % of women looking for a midwife in Montreal do, that the waiting lists at Montreal's two birthing centres were too long to accommodate her. In order to get the type of care that she wanted, Mattingsley turned to the network of underground midwifery, and hired an unregistered midwife. To get a birth certificate in Quebec, it was necessary at that time to have a doctor or a registered midwife attest to the birth; as Mattingsley could not get access to a legal midwife, and had made the choice not to have a doctor, neither was present at the birth, and Mattingsley could not obtain a birth certificate for her baby.
Since Heather Mattingsley's case, Quebec has attended to the surface cause of the problem, but not to the root issue. The requirements for obtaining a birth certificate have been changed (now, one needs only two signed statements of witnesses to the birth not related to the child), but a woman who wants access to the care of a registered midwife in Montreal still only has a 1/5 chance of getting it.
The key word is registered. There isn't, at the moment, a significant lack of university-educated and well-trained midwives in Quebec; in fact, the 15 annual graduates of Quebec's only midwifery program, at l'Université de Québec à Trois Rivières, have severe difficulty in finding full-time employment upon graduation.
This means that both sides are losing: expectant mothers who want a midwife-supervised birth are unable to have one, and midwives who have spent years studying and attending births in order to be able to practice their profession cannot do so. It doesn't seem to make sense.
The barrier is actually fairly straightforward. There is a deficiency, not in the demand of mothers or in the supply of midwives, but in the number of birthing centres in the province. In Quebec, it is illegal for midwives to practice independently, and therefore birthing centres are an essential requirement for midwifery professionals who wish to practice their trade legally within the province. The lack thereof causes many midwives to seek work outside of Quebec (for example in Ontario, where midwifery is more established), or to turn to underground midwifery.
Obstetrical care is the other available option, however there is also a shortage of obstetricians in the province. One year ago in Le Soleil it was reported that the Association of Obstetricians and Gynaecologists of Quebec was too understaffed to adequately respond to the needs of the pregnant women of the province, and that the problem would only worsen over the next few years as many doctors reach retirement.
The development of midwifery care in Quebec seems to be an obvious solution to this problem, as midwives could fill the gap left by a lack of obstetrics professionals. Additionally, while obstetricians are an important resource during the birthing process in order to deal with high-risk births and emergency situations, midwives put forward the case that for normal, low-risk pregnancies, there is no reason to turn primarily to hospital care. In fact, a Statistics Canada survey conducted in 2006 found that women who gave birth with a midwife were more satisfied with their birth experience than women who gave birth under the care of doctors and nurses.
One complaint which has been levelled against hospitalized birth is the pressure which is exercised within the hospital environment to medicalize the birthing process. Claudia Faille, the president of Regroupement Les Sages-Femmes du Québec commented during a CBC Radio interview that obstetrical care during pregnancy is the equivalent of seeing a pneumonia specialist for a cold. In the hospital environment, medical interventions are often used to treat what would otherwise be safe and natural childbirth processes.
One example of this tendency is the considerably high rate of caesarean births in Canada. The World Health Organisation recommends that the rate of C-sections should not exceed 10-15 %, and yet in Canada this percentage was at 17 % in 1995, and had risen to 23 % by 2003. In 2006, more than one in four (26 %) of all babies in Canada were born by caesarean. Giving birth by C-section is a serious surgery which involves varying lengths of recovery time and the possibility of risks and complications. According to a study done in 2006, three quarters of births in Canada involve medical intervention of one form or another (which could include inductions, C-sections, epidurals, etc.). While this form of childbirth has become part of the standard initial approach in Canadian hospitals, it is an experience which many women wish to avoid.
Midwifery's stance is to treat childbirth as natural, and to resort to medical interventions only when it becomes absolutely necessary.
One quarter of women in Quebec would choose to approach childbirth in this fashion, with the help of a midwife, if they could. Yves Bolduc, the Minister of Health and Social Services, has been accused by the midwifery community of proceeding too slowly in the development of new birthing centres, which would allow all of those women to give birth in the manner and at the location of their choosing. In 2008, the provincial government announced a plan to build 13 new birthing centres by 2018, and to increase the percentage of women treated by midwives to 10 %; however, only 2 new birthing centres have in fact been opened in the four years since this promise was made (there is a total of 13 birthing centres in the province), and midwives care for only 2-3 % of women.
This past May, Bolduc announced his intention of accelerating the development of birthing centres, by changing the manner in which the projects would be financed (the previous system caused massive delays). He acknowledged that women should have access to the care of midwives if they would like it, and that they should be free to give birth in the location of their choosing.
For the women who are now pregnant in Montreal and elsewhere in Quebec, and who hope to give birth under the supervision of a midwife, these promises (though optimistic for the future) will not be fulfilled in time to give them the service which they want, and which they have a right to have. Many of these women may turn to the underground network of unregistered midwives for help, as Heather Mattingsley did, and others may be forced, against their wishes and by necessity, into hospital care.
When care by midwives has been shown through studies to be a reasonable, and even a preferable, alternative to obstetrical care, it is unfortunate that after 13 years of provincial regulation it still remains out of reach for most women in Quebec today. The rising demand for midwifery care and the overburdened state of obstetricians both call for the same solution, and that is the active creation of birthing centres. Even if the promises made by the government are actually fulfilled, the work to continue the development and support of midwifery in the province will be ongoing. If this issue is given the attention that it deserves, then over the next few years, perhaps more women will gain the ability to make their own choices in how their bodies are treated, and how their children are brought into the world.
A lot can be accomplished by spreading awareness. If the need for access to midwifery care becomes more widely known and accepted, and if the reasons for this need are better understood, the chance of obtaining adequate results from the government will increase.
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You can read in more detail about the information in this article by following the links below:
Open File: "Certificat de naissance: la directive qui soulage les parents" October 4, 2011.
CBC News: "Montreal family still fighting for birth certificate" August 26, 2011.
TVA Nouvelles: "Maisons de naissance: Les ressources manquent au Québec" August 17, 2011.
Le Soleil: "Crise en gynécologie: le PQ veut plus de sages-femmes" January 29, 2011.
La Presse: "Sages-femmes: diplômées sans emploi" January 28, 2011.
La Tribune: "Toute une cohorte de sages-femmes sans emploi" January 26, 2011.
La Presse: "Sages-femmes en chômage" January 19, 2011.
Macleans: "A midwife crisis" November 20, 2008.
CBC News: "Women happier when babies delivered by midwives: Statscan survey" November 28, 2007.
Canwest News Service: "C-section rate in Canada continues upward trend" July 26, 2007.
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