Stating that midwifery remains an elusive service in the NWT despite a decade of promised action and funds, one midwives’ group is pushing for change.
The Midwives Association of the Northwest Territories issued a public call to action after midwifery was the subject of an exchange in the NWT legislature last week.
Questions from Thebacha MLA Frieda Martselos revealed a funding shortfall of nearly $2 million preventing the swift expansion of the service to more communities.
“Midwifery services are client and family-centred and foster trusting relationships between clients and midwives,” the Association’s statement read.
“This relationship-based care directly contributes to a safe environment for marginalized people and the provision of culturally competent care.
“If the GNWT is unable to find funding to increase access to midwifery services, our communities will continue to experience the impacts of colonization and expectant parents, newborns and their families will be at an increased risk of adverse health outcomes.
“The time to take action and move forward with expansion of midwifery services is now.”
Heinrichs, formerly based in Hay River and now in Yellowknife, subsequently told Cabin Radio all residents of the territory deserve access to midwifery but the GNWT had “fallen behind on some of the commitments that they’ve made.”
Currently, only Hay River and Fort Smith have dedicated clinics. While a midwife has been hired in Yellowknife to strengthen territory-wide services, there is understood to be not enough funding for the service to be offered in the city with any consistency.
As a result, people in smaller communities must often travel to give birth or receive related in-person care. The cost of travel for midwife appointments not related to labour is not covered by the territory’s medical travel program.
A report released in 2017 called for stabilization of the service in Fort Smith and Hay River, where midwives reported being understaffed, on call frequently, and consequently at risk of burnout. The same report recommended expansion of midwifery services to Yellowknife, the Beaufort Delta and the Tłı̨chǫ.
In 2019, then-health minister Glen Abernethy reiterated the NWT government’s commitment to that expansion. However, funds for the endeavour – predicted to appear in the 2020-2021 budget – appear to have been consumed by the onset of Covid-19.
“That makes a lot of sense. Our priorities had to change a lot,” Heinrichs said. “But we’re at a place now where we need to make sure that we’re not neglecting other areas of healthcare.
“Midwives are actually well-positioned to help support the healthcare system through Covid because we are able to provide flexible care. We could do virtual appointments, we can see people in their homes so they don’t need to travel. It’s time for the big picture to be looked at.”
To Heinrichs, a successful midwifery expansion would ensure the service is fully integrated into the NWT healthcare system rather than simply tacked on.
“It’s really important that we’re part of a team. We can’t do it alone,” she said. “Working with physicians and nurses as part of the healthcare system is how midwives are able to achieve the best health outcomes.”
Comfort and encouragement
In Hay River, Fredelle Deneyoua used midwifery services for each of her two pregnancies.
“When I had my son in 2015, I was a first-time mom,” she said. “I had no idea about babies or nothing, and it made the appointments so comfortable, where you would go in, they would assess you, they would explain things to you.
“If you have any questions, you could just call your midwife, any time of the day.”
Deneyoua gave birth to her second child with a midwife, which she said beat travelling to Yellowknife for the birth of her son four years prior.
“I didn’t like that experience because I didn’t know anyone there,” she said. “There were so many people in another room all the time.
“When I had Haley [her daughter] here in Hay River, it was just my midwife and one nurse. It was awesome. They make you feel comfortable, and they keep talking to you and encouraging you.”
Cara Gordon, in Fort Providence, has two children and is expecting her third. She said midwives taught her useful techniques that helped during her birth and offered her valuable support both before and afterward.
Even with the funding shortfall, Gordon thinks there are other things the GNWT can do to improve access to services, such as covering travel costs for appointments.
“Even an itinerant midwife that could come so you don’t have to travel every time that you go,” she suggested. “Maybe one month, they come here, then the next month you travel.”
Gordon thinks more education about the service would help, too.
“I certainly had a misconceived idea of midwives and their primary role,” said Gordon. “I thought it was mainly a support during birth, and then I quickly learned it was way more than that.
“I think it’s a really important service, not just in the medical sense, but also to provide that emotional and mental support.”
Midwives offer a range of services beyond pregnancy, birth, and postnatal care. They write prescriptions for contraceptives, provide breastfeeding support, and facilitating access to procedures ranging from abortions and bloodwork to ultrasounds and pap tests.
“They can keep an eye on vulnerable parents or first-time parents that can’t advocate for themselves as easily, or maybe don’t have the voice or the confidence to question things,” Gordon said.
“It can stop people falling through the loopholes as well, I think, if you have these services more readily available and access to everyone.”
“Midwives provide continuity of care, they provide choice of birthplace,” she said.
“They provide really easily accessible care and meet clients where they’re at, doing home visits or meeting clients in places other than the clinic, things like that.
“It would benefit the residents of the Northwest Territories greatly to have access to midwifery care.”