A little over a month ago, Sherri Collins gave birth at home to a son, during a worldwide pandemic.
The idea of having a home birth was a given. Collins, who grew up in Gambo, N.L., but now lives outside Calgary, A.B., says she loved the thought of birthing at home with a midwife’s care. It's also something of a family tradition - her great-grandmother was a midwife in Gambo, "back before midwives became a thing," she says.
Collins had wanted her daughter to be born at home, too, but with concerns of a large baby with risk of the shoulders getting stuck, they opted for a hospital birth. The experience, she says, was not ideal.
She could have no family or friends around to help, as her mother and husband had to leave the hospital after visiting hours. On top of that, her roommate talked on her cellphone in the middle of the night.
“It was awful. I was a complete zombie when I brought my daughter home,” says Collins.
Comparatively, during her homebirth, Collins felt less stressed and could therefore produce oxytocin, required for a less painful birth. She put to use skills she’d gained in an online hypnobirthing course to help rid herself of fear of risk, was surrounded by family and friends, and was more comfortable at home than she was at the hospital giving birth.
Collins says it was easy to orchestrate the homebirth process in Alberta during COVID-19 - but that's not the case everywhere, including Atlantic Canada.
More interest in Atlantic Canada
CJ Blennerhassett, a registered midwife and president of the Association of Nova Scotia Midwives, says that although no formal study has been completed, they have heard anecdotal reports from midwives that there have been increased inquiries about home births in Nova Scotia during the pandemic.
Megan Burnside, a coordinator with BORN (Birth Options Research Network) - an organization that supports women's access to birthing choices through regulated midwifery, doula care and family-centered maternity in P.E.I. - agrees.
“There has been heightened anxiety about heading to a busy public place, like the hospital, during times when the province has had active cases,” she says.
Midwifery services alleviate hospital pressures as well as mothers’ worries, says Brianna Thompson, the president of the Association of Midwives of Newfoundland and Labrador.
Moms cared for by midwives generally spend less time at the hospital, both during labour and postpartum, says Thompson, something that's appreciated by new parents during a global pandemic, says Thompson. If all goes well, midwives can discharge their clients from the hospital just a few hours after giving birth if all is well, and the midwives then follow up in the home.
While early discharge has always been appreciated by midwifery clients, visitor restrictions due to COVID-19 has made this even more attractive in Newfoundland, where during the height of COVID restrictions, the new mom’s support person had to leave the hospital soon after the birth rather than stay for the duration of admission (typically 24 hours minimum), explains Thompson.
“Keeping your family together while still having access to high-quality care and support in the home is of great comfort to families. For the hospital, this means more available beds when clients go home to theirs,” says Thompson.
Not just pandemic
Burnside, however, is not convinced that the increase in interest in home births can solely be attributed to the pandemic.
She believes the increased interest comes from families who have experienced birthing at home in other provinces who are not willing to give up their autonomy and submit to hospital protocols.
There are also women who have had bad experiences birthing in hospitals and wish to avoid the same setting, she adds.
Women who choose freebirth - intentional unassisted childbirth, without the assistance of any medical support - is a smaller but also important dynamic, says Burnside.
Not enough midwives
The idea of home births, however, is easier said than done in Atlantic Canada.
“The needs of many Island families, particularly those who are interested in a natural birth with little to no interventions if possible, and those who are at risk due to previous trauma or other societal risk factors, were not being met even before the pandemic,” says Burnside.
P.E.I. does not yet have any registered midwives, says Burnside, although families have been asking for services for many years. The provincial government has stated numerous times that registered midwives will be available in P.E.I. soon, however, and Burnside says the previous health minister stated that families should be able to access this service by fall 2021.
Nova Scotia is a bit further along, with 17 registered midwives in the province; however, they are only three practice sites in the province. There are four full-time equivalent positions each with the Highland Community Midwives and the South Shore Community Midwives, and another eight with the IWK Community Midwives, explains Blennerhassett.
"For it to be offered in every area of the province, there would have to be registered midwives in every area of the province which we are, of course, in support of," she says.
That's something she doesn't believe would be hard to do - there are midwives anxious to work in the province.
“In the last three months alone, I have spoken to five midwives looking for work in Nova Scotia. And yet, there are no jobs. Pregnant people want access to midwifery care and midwives want to work in Nova Scotia," Blennerhassett says.
In Newfoundland, the first and only practice began taking clients in December 2019 in Central Health, says Thompson.
This year, she says, will be the first year registered midwives are offering and attending home births in the Gander area. Elsewhere in the province does not have access to registered midwives, however.
In fact, Thompson herself became the first health authority-supported home birth in Newfoundland with registered midwives when she gave birth to her second child, attended by her colleagues.
“It felt very special to have worked so hard towards implementing home birth in Central Health, and then experience the fruits of our labours first hand,” says Thompson.
COVID monkey wrench
Just as the program was getting going, Thompson says COVID-19 presented challenges. Within days of Newfoundland's first midwifery birth, the province was on lockdown. Hospital policies were changing almost daily, while midwives were just getting their bearings, she says.
Like every profession, midwives have had to adapt.
“Truthfully, it pales in comparison to all of the ways pregnant people have had to adapt due to COVID-19. It is in some ways a markedly different experience having a baby right now,” says Blennerhassett.
It hasn't been easy, says Burnside. In P.E.I., doulas couldn’t attend hospital births during certain periods of the pandemic. Nitrous oxide, a form of pain relief chosen by families hoping to birth naturally, was removed as an option for a while as well.
Added to that, postpartum home care visits - previously attended by public health nurses - were replaced with phone calls on the Island for a period of time, says Burnside.
“Families who felt there were already many barriers to delivering naturally, were faced with even more barriers and restrictions for their labouring,” says Burnside.
Not only were there these challenges, but Burnside says because of the pandemic, midwifery was dropped from the P.E.I. government's priority list. They will, however, continue to advocate for change.
Instead of shining a light on the need for midwifery in Atlantic Canada, Thompson says the pandemic did just the opposite.
The historical moment of the first registered midwife-attended birth ever in Newfoundland went virtually unnoticed by most because of COVID-19, says Thompson. The program has yet to have its celebration. The pandemic has put the breaks on progress in the past year at the Newfoundland and Labrador government level.
Hope for change
The World Health Organization had named 2020 the Year of the Nurse and Midwife - something that was largely passed over due to COVID.
Better access to midwifery services and more homebirth options would have been beneficial during the height of COVID-19, says Burnside.
"Midwifery services would have provided continuous support by a trusted caregiver easing some uncertainty during an uncertain time," says Burnside.
The possibility of home births would have removed the fear of needing to labour at the hospital, especially at the beginning of the pandemic when fear was high about how far spread COVID-19 was in our communities, she adds.
Midwifery also keeps healthy individuals and their newborns out of hospitals, whether a client chooses to birth at home or not.
“Midwives offer excellent health outcomes for parents and babies while saving the provincial healthcare system valuable money,” says Blennerhassett.
After her own experience in Alberta, Newfoundland native Collins says she would strongly encourage parents to investigate the benefits of a home birth where available.
Her hope is echoed by provincial midwifery associations.
“Our hope is that midwifery becomes a priority and that we start moving forward again. Families deserve the opportunity to avail of midwifery care during their childbearing years to optimize their health in pregnancy, childbirth and the postpartum period - especially during such difficult and uncertain times,” says Thompson.
