This article was written by Lezlie Lowe for the Fall 2014/Winter 2015 issue of Izaak Magazine – an in-depth, behind the scenes, all-access publication highlighting the incredible, everyday happenings at the IWK Health Centre. IWK Midwives make it possible for more families to welcome babies to the world safely at home.
Shelly Juurlink sits in her Fall River living room, pointing left, pointing right. There’s the spot on the floor where she laboured for eight hours in a birthing pool. There’s the spot the futon was set up, where her seven-pound, five-ounce boy slid out, under the care of Shelly’s husband, Perry Sankarsingh, and the couple’s doula and two IWK midwives.
“We christened this place,” Shelly says, laughing. “We were really happy we were able to do it here.”
After their son Lennon was born, Perry cooked breakfast for the whole team — coffee, eggs, toast and fresh mango.
Shelly rested, ate and nursed the baby while everyone hung out for a few hours, talking about the birth and debating what name this new little baby, who was not arriving home, but being home for the first
time, would be called.
“They helped make it a celebration,” says Perry of the midwives and doula.
This isn’t a birth the way many Nova Scotians picture it, and it’s one the IWK is happy that women in HRM are able to access.
Midwife-attended births became a core part of IWK care when midwives were first registered by the province five years ago. IWK midwives’ scope of practice includes hospital births and home births,
both with a focus on low-intervention and relationships.
“We don’t get the outcomes we get because we have ‘registered midwife’ after our names,” says Shelly’s midwife, Kelly Chisholm. “We get the outcomes we get because we spend so much time with women.
We develop a trust.”
Chisholm and her colleagues remain in contact with some clients for years. (Almost on cue, a mom and new baby walk into the café where Chisholm and I are meeting. They hug, and coo over the baby, who’s nursing inside a Snugli. The scene is repeated with a different mom a few minutes later. Another former client walks by the window and waves enthusiastically).
“There’s barely a coffee shop I can go to without running into somebody,” says Chisholm, who has attended between 400 and 500 births. “It’s really nice.”
The 41-year-old’s story of deciding to go into midwifery has an unlikely setting indeed: she watched a mother sea turtle lay her eggs on a Guyanese beach as part of an overseas youth outreach trip during
IWK midwives conduct prenatal visits off site at a Dartmouth clinic that isn’t much like a clinic at all. “It’s set up so that women feel like they’re more in their living room,” Chisholm says.
There are chaises instead of exam tables and space for soon-to-be siblings to play. (A big bonus for Shelly, who needed to bring her two year- old daughter, Lilah, with her to her check-ups). Prenatal appointments last about 30 minutes. Some postnatal visits are conducted in the family home.
“In terms of a service experience,” says Perry, “it’s great for the family. We never had to pack up a little baby and go to the hospital for check-ups when he was two or three weeks old. They came there.”
Perry says home birth wasn’t even on his radar before he met Shelly. With their first baby, he says, it took some convincing. Now he’s a convert.
“Going to bed as a family two hours after you have given birth is a pretty great feeling.”
In a family practice care model, women may have good continuity throughout their prenatal care, but when the day (or night) of delivery arrives, that woman’s physician may not be on call.
“Midwives are on call for one another,” says Vine, “but they work hard to ensure that the woman knows that other midwife in the case of her primary practitioner being busy. It’s partly the relationship you are able to form throughout the journey.”
Shelly was lucky to get into the IWK midwives’ care. She and Perry had moved to Nova Scotia from Ontario mid-pregnancy and were first with a midwife in Antigonish. They moved again to Halifax and happily made it onto Chisholm’s roster only a month before Lennon’s birth.
A little fewer than 10,000 babies a year are born in Nova Scotia, half of them at the IWK. Only one per cent are midwife-attended.
“It’s a very small subset,” says Vine, “but it could be bigger. Because the number of women who have normal, low-risk births is a fairly large group.”
The small number of midwife-attended births isn’t because the practice — which is a registered medical profession and thousands of years old — is an outlier. In fact, demand for midwifery services in HRM far outstrips the IWK’s resources.
Chisholm is one of six midwives (four full time and two part time) in a practice that takes in 16 to 20 women a month. Protocol requires a midwife and a second birth attendant at all births, so the program just hired five birth-unit nurses to act as home-birth attendants.
But that doesn’t change the demand for the service. “We could keep at least one or two more full-time midwives busy, starting tomorrow,” Chisholm says. Chisholm, who’s in her 14th year of “baby catching”, was self employed for a decade in B.C. and New Zealand before coming home to join the IWK. But she feels strongly about hospital affiliation.
“We needed to be a part of the IWK when we became registered, because that was how buy-in was going to take place in terms of all the other professions. The public has a huge amount of respect for the IWK, so it gave us the credibility instantly.”
Sanction, it turns out, has been a two-way street. Births at the IWK run the gamut from those following the most healthy low-risk pregnancies, to the most complicated highrisk situations.
Jocelyn Vine says the IWK has a strong record when it comes to low-intervention birthing for low-risk pregnancies. But the midwives, she says, “have helped ground us in that practice. I think we were good before. But we are better now.”
Low intervention was exactly what Shelly wanted and midwifery was her chosen road to get there. Her daughter, Lilah, was born at home with the assistance of a midwife in Guelph. Even with her first pregnancy, she didn’t have any reservations about delivering at home. Trust in the home-birth process,
Shelly says, stems from trust in the midwives.
Perry admits he was concerned about the what-ifs, more with this birth than with their first. In Guelph, the couple were three minutes by car from the hospital. Here, the IWK is half an hour away on Hwy. 118.
The midwives reassured him that signs of trouble emerge early enough that they can do a transfer of care in time from anywhere in HRM if that’s what’s needed (up to 30 minutes from the IWK). Also, Chisholm and her colleagues don’t take women into their practice whose pregnancies are likely to need hospital care, based on a specific list of medical exclusions.
Shelly was a healthy 35-year-old on her second low-risk pregnancy. Chisholm had no reservations. “We have this general feeling,” Perry says, “that science will save us. So, it’s very natural for people, when they are having children, to want to have the best care available. So they look to hospitals. But I think that we have made pregnancy into an illness as opposed to a natural process.”
Perry doesn’t discount the need for hightech care in complicated pregnancies. But when it’s appropriate, he says, midwifery should be available.
“I realize that we were lucky to have had the experience we had,” he says. “Not everybody has that experience. Shelly’s labour was pretty routine, uneventful. So we felt pretty safe.”
Chisholm, for her part, is eternally sanguine. “I get to be with people during one of the best times of their lives,” she says more than once, almost amazed at the truth of it. “And I get paid to do it.”