Unable to meet demand, New Brunswick midwives call for greater access to service

New Brunswick midwives are hoping a review by the province will lead to the expansion of midwife services in the province, which have remained unchanged since they started in 2017.

Right now, the province has an $895,000 budget for the Fredericton midwifery program. That funds four midwife positions, and they can serve clients within a one-hour catchment area. Outside of that, New Brunswickers are unable to access midwifery services.

Even within their jurisdiction, though, midwives say they can't meet the demand.

Brittany Stairs, president of the New Brunswick Midwives Association, said she's been told the province's evaluation, results of which will be released mid-2022, is the first step in determining what happens with the midwifery program, and she's hopeful it'll lead to expansion.

"All the time, I'm getting messages and emails from people asking what they can do and how they can receive midwifery care, and sometimes they're pleading and saying how desperate for care they are, but because they don't fall within the catchment area, they're not able to be seen," Stairs said.

She said a first step would be hiring more midwives for the Fredericton location. Then, a satellite location, or even a second, permanent location in the Woodstock and Upper River Valley area could follow.

In a statement, the province said the review is being being done by a third party.

"This evaluation will enable evidence-informed decision-making regarding the future of the program in New Brunswick," it said in a statement. "This report is expected to be completed by mid-2022 and will be made public."

The impact the Fredericton Midwifery Centre has had on the community since it opened has been significant, Stairs said. Midwifery is often about meeting people where they are and bringing care back to the community, she said.

The centre even holds space each month for priority populations, which can include people with disabilities, people from diverse backgrounds, and people of different socioeconomic status.

Midwives can also help fill gaps in New Brunswick's health-care system, Stairs said. As primary-care providers who receive four years of training to become certified, midwives could also perform Pap smears or administer vaccines, she added, especially in rural areas where health-care access can sometimes be challenging.

That would require amendments to New Brunswick's Midwifery Act, which only allows midwives to assist pregnant and postpartum people.

Still, the first step is getting more midwives in New Brunswick. Stairs said there are no midwife schools in the Maritimes, so people have to leave the region to receive training or relocate to the Maritimes.

Since the demonstration site opened in 2017, Stairs said there's been turnover. Some midwives have gone on leave, giving other midwives the chance to step in for short-term contracts.

"Asking people to move from Ontario and B.C. to come cover a six-month, temporary position isn't super sustainable," she said. "If midwifery was expanded across New Brunswick and there were a lot more midwives, it would be a lot more tenable for somebody to come and take a position."

Taking the position was a gamble

Ursula Rinne received her bachelor's degree in midwifery at Laurentian University in Ontario last June. She moved to New Brunswick with her partner last July to accept a six-month contract at the demonstration site.

Like Stairs, Rinne said she wants to see midwifery services expanded in New Brunswick, which she said could be helpful in rural areas.

"We could be a very useful tool to address some gaps that are found in health care, outside of prenatal care," she said, also referencing Pap smears and vaccines. 

Right now, the midwives have a caseload of about eight or nine clients per month, and about 10 to 20 people aren't accepted into care each month.

"Outside of that though, we do have quite a few people calling into the clinic or emailing the centre in regards to care outside of our radius," Rinne said, adding those people can't be accepted, even if they're just one or two minutes outside of the one-hour boundary.

Rinne met her partner, who was born and raised in Fredericton, in Ottawa. She took a break between her third and fourth year of study to give birth to their daughter, and during that time, she lived in New Brunswick.

"I basically fell in love with the province and with the city and made it a personal decision to try and get out here as soon as I could as a midwife," she said.

But taking the position she has now was a gamble, Rinne said. She said she wanted to get her foot in the door, hoping to find a permanent position down the line.

Rinne, who's originally from the Niagara region, hopes to stay in the Maritimes once her contract is over, and she said she'll look at New Brunswick, Nova Scotia, and Prince Edward Island, which is supposed to have a midwifery program by the end of this year.

"That would be kind of our first goal, but if work is not to be found here, we would have to make the trip back to Ontario, essentially."