Midwives in the NWT say the birthing suspension at Yellowknife’s hospital is made harder to bear by the knowledge midwifery positions in the city haven’t been filled.
The Midwives Association of the NWT says four positions created for Yellowknife earlier this year have not been filled. Two, the association says, have not even been advertised yet. Two were posted last week.
Heather Heinrichs, the association’s president, said she understood funding to fill the positions had been available since June.
“If the staffing shortage at Stanton hospital has come to forcing people to leave the territory to give birth,” Heinrichs asked, “why were those positions not posted sooner?”
At the end of March, the territorial government said it would inject an extra $600,000 to expand its midwifery program ahead of schedule following consultation with regular MLAs.
That money allowed the program to advance to its second phase, which health minister Julie Green said would provide four midwives in Yellowknife, one in Hay River, and one in Fort Smith.
The positions in Hay River and Fort Smith were “posted promptly” in the summer and filled, Heinrichs said by phone on Tuesday, but the Yellowknife positions were not.
Heinrichs believes the current crisis – labour and delivery service has been suspended at Stanton Territorial Hospital, and dozens of families must head south to Edmonton instead – could have been avoided, or at least helped, with midwives in place.
Four midwives in the city would have provided “capacity to weather stresses like this [with] a strong, inter-professional team,” Heinrichs said.
“We don’t know exactly what the holdup is. It must have been foreseen that this situation, where birthing services are going to be suspended, was going to happen. And it doesn’t make sense to the midwives’ association why those positions wouldn’t have been posted at the same time that the positions in Fort Smith and Hay River were.
“Having midwives working in Yellowknife could reduce the strain of this staffing shortage on the nurses … potentially meaning that folks wouldn’t be forced to leave their communities for birth.
“We see that in Hay River and Fort Smith right now. Despite the nursing shortage here, midwives are able to continue to provide community birthing services to many clients.”
Heinrichs said her association was aware of “a lot of interest” from midwives outside the Northwest Territories who would consider working in Yellowknife, as well as former students who carried out placements in the city and would most likely return.
“They haven’t been able to even apply on those jobs,” she said.
Jeremy Bird, a spokesperson for the NWT’s Department of Health and Social Services, confirmed by email that two of the four positions were posted on November 15.
The other two, he wrote, are expected to be posted “some time in 2022 but, as of now, I can’t say within any real specificity when during the year this will happen.”
The reason for that timeline, compared to Hay River and Fort Smith, was not immediately clear.
Bird suggested that while the midwives will be based in Yellowknife, their ordinary role will be aimed more toward smaller communities.
“The aim of this Yellowknife-based midwifery team will to be enhance the quality of prenatal care being delivered to women and families in the communities,” he wrote, “with a particular focus on the Tłı̨chǫ, Dehcho, and Sahtu regions, by offering outreach services and supports to clients and community health nurses.”
Other communities know how it feels
Meanwhile, in the territory’s legislature, health minister Julie Green faced shock from regular MLAs at the collapse of labour and delivery services at Stanton.
Green said managers had been unable to fill 46 obstetrics shifts in the coming months, necessitating the closure. Up to 120 families are understood by the minister to be affected, including 25 to 30 from Nunavut’s Kitikmeot region who would ordinarily travel to Yellowknife.
“I refuse to accept this,” said Kam Lake MLA Caitlin Cleveland.
“Some families have three weeks’ notice that they will have … less work and less income, be moved from the safety of their community and support system, potentially deliver without their partner, potentially be left with no support for older children, and then be expected to travel home and isolate with a newborn.
“This is a huge step in the wrong direction for our entire territory and a decision I simply cannot accept. We should be fighting for more and not less.”
Lesa Semmler, the Inuvik Twin Lakes MLA, carefully pointed out that while the news was deeply unwelcome, many families in smaller NWT communities have long faced the prospect of lengthy trips elsewhere to give birth.
“We now have families being impacted by this closure, having to do what families from 29 other communities have to do when they are 37 weeks – leave their home, their support, their lives until after they deliver,” said Semmler.
Green said much the same.
“While this is a novel situation for Yellowknife, of the 23 births anticipated from December 10 to the end of the month, eight are from Yellowknife and 23 are from the communities. And my point in raising that is that this situation – of having to leave family and supports and come and live in a place that we’re not from for three to five weeks – is in fact a common Northwest Territories experience,” the minister told colleagues this week.
“That doesn’t make it great for people in Yellowknife. But we need to consider that we need to make the situation equitable among the people who come from small communities and those in Yellowknife who are now inconvenienced by the closure of the obstetrics unit.”
Green said that was one reason why medical travel support was not immediately being altered to give extra assistance to families affected by this week’s suspension. She did, however, tell Cleveland affected people were being contacted and “systemic changes to accommodate families” were not out of the question.
One nurse with direct experience of working at Stanton’s obstetrics unit acknowledged the situation Yellowknife families now found themselves in was one other communities face all the time.
“There’s a lot of privilege in Yellowknife, being able to deliver at home when most people in the NWT have to travel to deliver,” the nurse said.
“That’s the norm for most people – half of the women in the North. But it’s not OK. You should be able to deliver at home, with your family, in your hometown.”
Heinrichs agreed, and listed the impacts on people who must travel to give birth: the financial outlay, anxiety or depression, isolation, and interruptions to early bonding and breastfeeding on the trip home.
“When we’re evacuating people for birth, and we’re interrupting all of these processes, there’s a really great potential for harm,” she said.
“This is a massive backward step.”