Midwives and the changing maternal health landscape

How midwifery fits into the changing maternal health landscape

Each year in Canada, over 300,000 people give birth. High quality, accessible care helps ensure their safe transition from pregnancy, to birth, to the postpartum period. More Canadian jurisdictions are regulating and funding midwives, and demand for midwives has grown in recent years.

Kellie Thiessen, a registered midwife and nurse with experience in both child and maternal health and the previous director of the bachelor of midwifery program at the U of M, highlighted the importance of midwives in health care.

“Midwives are a critical player in the health-care system because they have a broad scope,” she said, noting the ability of midwives to meet the unique needs of different communities, whether rural, remote or urban.

Though midwives are often associated with birth, their range of care extends beyond that. Midwives are the primary care providers for birthing parents and infants up to six weeks postpartum, a formative period of transition and adaptation. Birthing parents and infants experience physiological adjustments, while the entire family navigates social and emotional changes.

The postpartum care given by midwives and other health-care providers has been shown to help patients recover faster after giving birth.

“I think one of the most valuable things a midwife does is that postpartum care,” Thiessen said.

Thiessen also emphasized the ability of midwives to provide care for people at home, bringing care to the community. While other providers are often unable to offer care outside of hospitals and clinics, midwives allow patients to choose where they give birth.

Additionally, because midwives take on smaller caseloads, they are able to spend more time with each patient.

“They provide a complement of care that is more comprehensive in terms of their ability to stay engaged over a longer period of time because they don’t carry high volumes,” Thiessen said.

“There are some very unique aspects of the care,” she added.

In 2016, Thiessen co-authored a study comparing maternal outcomes of Manitoban women’s experiences of midwife-led and physician-led birthing care. The study found that women cared for by midwives experience lower odds of having an episiotomy (incision into the perineum to ease childbirth), epidural and caesarean delivery. Their infants are less likely to be admitted to neonatal intensive care units.

The study concluded that increasing integrated midwifery services can improve the effectiveness of Manitoba’s maternal services.

Other studies similarly demonstrate the importance of midwives. A 2021 report by the Commonwealth Fund found that integrating midwives into global health-care systems has the potential to provide 80 per cent of essential maternal care. This could avert 41 per cent of maternal deaths, 39 per cent of neonatal deaths and 26 per cent of stillbirths.

Thiessen aims to encourage more midwives to engage in research, and to help mentor midwife researchers. She noted that midwives’ participation in research, even in an informal capacity, helps to inform the work of those leading maternal health research. Building capacity by increasing the number of midwives in research ensures that midwives have a voice at decision-making tables and can influence policymaking.

She explained that midwifery research provides politicians with the information needed to make decisions about maternal health care. Leading research allows midwives to be “influencers” of policy.

“The other goal is to continue to be in leadership positions to help move the profession forward, so we become more of a critical mass and are seen as an essential service to families,” Thiessen said. “We’re not there yet.”

To get there, Thiessen emphasizes the importance of communities advocating for midwifery services. While midwifery may be integrated and regulated in Manitoba, Thiessen said midwives lack the support needed to steadily grow the profession.

This is especially important considering the lack of health-care providers in rural areas of Manitoba.

Supporting midwifery improves the quality of maternal health for rural and urban parents alike.

“We absolutely need people to continue to advocate for the value of these services and how they affect families across the lifespan,” Thiessen said.

“We need to be looked to as experts in the field, and we need to be considered an essential service.”