‘Midwives could help a system that is fragile and failing women’

In June, Gracia Penner gave birth at home in her downtown Yellowknife apartment without any medical assistance. She said she would have preferred to have had a midwife present.

“Birthing has always been pretty normal to me and something I’m comfortable with,” said Penner, originally from Manitoba and the oldest of eight children.

She moved to Yellowknife two years ago. When she became pregnant, she and her husband started discussing how they wanted the birth to go.

“A midwife was my first choice,” she said. “The most comfortable for me would have been to have a midwife and hopefully had a home birth. But I would have considered having a midwife attended birth in the hospital.”  

When she looked into it, she learned the closest midwives were in Hay River. “So that wasn’t really going to work.”

She brought up the idea of having an unassisted birth to her husband. While they were on the fence at first, she said they ultimately decided on a home birth, even if it was going to be without a medical professional present.

She gave birth at home on June 15 with her husband and mother present. Penner had what’s called a freebirth, meaning there was no medical or midwifery assistance.

Leading up to the birth, Penner said, she had “routine prenatal care” at Yellowknife’s Stanton Territorial Hospital to monitor both Penner’s health and that of her baby.

She read up on certain conditions she was worried about, too.

“I wanted to know how those conditions worked, how to recognize if an emergency was happening, how to recognize if I was having high blood pressure and was at risk of preeclampsia or eclampsia. I wanted to know what does a shoulder dystocia look like? What do you do if there’s a shoulder dystocia? So mostly recognizing when you’re out of your league and you need medical help.”

Penner said she did most of the research and preparations for her freebirth on her own, which was “pretty anxiety-inducing while you’re pregnant.” It’s another reason she would have preferred a midwife, so she could “put that in their hands” and not have to be “quite as aware of every single thing that could go wrong while you’re giving birth and while you’re pregnant.”  

After giving birth, Penner presented her son, Fortress, at the hospital a couple of days later to have the birth documented and have him receive routine newborn care.

She was anxious about the hospital visit “because sometimes doctors aren’t really happy about people having a freebirth,” but said it went well.

“First thing people said to me was always just congratulations, and they were surprised that I had a home birth on my own, but no one was critical of it,” she said. “Definitely very respectful of my birth choice, which I thought was great.”

“I didn’t give birth at home because I was afraid of the hospital, or I thought they’d offer me bad care, or anything like that,” Penner said. Instead, she said she chose that option because “that’s where I feel the most safe and the most comfortable.”

“I really just think that women should be supported to give birth wherever they feel the most safe and comfortable,” Penner said, “Whether that’s at home or in a hospital or in a birth centre … choosing where you give birth is part of your reproductive choices.”

Funding cut for midwife positions

Currently, midwifery care in the NWT is only available in the communities of Hay River and Fort Smith, something that retired midwife Lesley Paulette calls “disheartening.”  

Paulette, who lives in Fort Fitzgerald, Alberta, practised as a midwife in Fort Smith for more than 20 years. She’s an advocate for greater access to midwife care, and is on the board of directors for the Midwives Association of the Northwest Territories.  

Earlier this year, the GNWT’s proposed 2024-25 budget included $48.4 million in reductions across departments. At the time, the Midwives Association of the Northwest Territories said the proposed cuts would affect four practitioner positions servicing Yellowknife, Behchokǫ̀, Dettah and Ndılǫ, a territorial manager’s position, and a senior midwifery consultant within the Department of Health and Social Services.

NWT residents protested in May against the planned midwifery budget cuts. In June, some midwifery funding was reinstated. Finance minister Caroline Wawzonek said she had made “modest” changes that included adding $331,000 to reinstate two midwifery positions – a manager and senior consultant.

Cutting the funding for positions in Yellowknife was “deeply troubling and really short-sighted,” Paulette said. “The NWT needs many more midwives.”

“The arguments being put forward by the government that midwives aren’t needed in Yellowknife because there are already birthing services at the hospital, that’s such a flawed argument,” Paulette said. “Midwives do much more than just deliver babies … they provide care from preconception right through to a long period of postpartum care.”

Midwives can also assist birth whether or not that takes place in a hospital, Paulette said.

“Part of the model is supporting a client’s choice about where they want to give birth, where they feel is going to be the best birthing environment for themselves.”

She said Yellowknife residents have been asking for midwifery care for “20 years, at least.”

Part of the demand stems from high turnover in care providers and the way things work at the hospital, Paulette said.

“You don’t know who’s going to be your care provider … you may never have met them before. We don’t have continuity of care, we don’t have choice of birthplace, we don’t get to develop our relationships – for the most part – with our care providers,” she said.

“Midwives could help to bolster a system that, right now, is really fragile and failing women. And yet midwives are not being incorporated [or] welcomed into the healthcare system in Yellowknife or anywhere else other than Fort Smith and Hay River.”

As a midwife, she said if people are choosing freebirth because they can’t get the midwifery services they were seeking, that’s a sad situation.

“It’s not a bad idea to have somebody around to give you a hand when you’re giving birth,” she said, adding that midwives know “what the normal birth process is like, what can go sideways, and how to be prepared for that.”

“Our job is to actually help women to feel safe and supported so they don’t have to stress about that. Their job is just to give birth to their baby, you know, to make an informed choice,” she said.

It’s possible the NWT may see more freebirths happening, Paulette said. “It’s happened in other places where midwifery services were not available.”

“When somebody says they would like to have had a home birth with a midwife, and then they can’t get that, and their only option is either go to the hospital to access the kind of service they didn’t want to have or birthing at home, alone … that’s a pretty profound commentary on our health system,” Paulette said.

“Women could feel so much more supported than that.”