When Newfoundland and Labrador's first registered midwifery clinic opened in Gander in early 2020, it was meant to be a pilot program that would help kick-start the profession.
But more than two years — and a pandemic — later, midwifery care has not grown beyond that Gander clinic, and the midwives who do practise at that clinic are unable to lead births because of staffing shortages and clinical diversions.
Deirdre Maguire, co-chair of advocacy organization Birth Justice N.L., said the closure of the Gander obstetrical unit — set to last until September — is the main challenge.
"We haven't seen any progress in expanding midwifery access. In fact, access to midwifery care is declining," explained Maguire. "What we're really worried about is that the provincial government's lack of investment in midwifery services is actually causing this much-needed profession to fail."
Midwives are primary-care providers who are trained to care for clients during pregnancy, birth and six weeks postpartum. They also provide choice of birth place, such as the option of a home birth.
Maguire said midwives typically work in small teams, and have longer, more in-depth appointments than doctors.
"Families really get to know their midwives and their midwifery team and so they have that trust and that support available when they give birth."
The current state of midwifery services is a far cry from the optimistic view painted by Health Minister John Haggie in late 2019, shortly before the Gander clinic opened.
"Once that site is up and running, I would expect other sites to follow along fairly quickly with a lot shorter lead time," Haggie said at the time.
But the number of practising midwives has dropped from four to two since then, and midwifery has not expanded beyond Gander. In a statement, the Department of Health said it's actively recruiting more.
"The provincial midwifery implementation committee will begin work with other regional health authorities to expand services in other parts of the province," said the statement.
Midwifery care in any form is only available at the Gander clinic, part of the Central Health region. Maguire said midwifery care is most in demand in St. John's, but would benefit other parts of the province, too.
"We would also like to see midwifery care made available to rural and remote communities who currently need to travel long distances in order to access any form of obstetrical care," she said.
Midwifery-attended births are more common in other provinces, accounting for 25 per cent of births in British Columbia and 17 per cent in Ontario, compared with just 1.1 per cent in Newfoundland and Labrador, according to the Canadian Association of Midwives.
Registered midwife Brianna Thompson moved to Newfoundland and Labrador to be a part of that first clinic, which opened a little over three years after the provincial government introduced long-awaited midwifery regulations in 2016.
"What brought me to Newfoundland and Labrador was the fact that it's at this, like, infancy in terms of registered midwifery. There are pre-legislation midwives and actually quite a rich history of midwives in the province," Thompson said.
Thompson, who is also a former midwifery client and the president of the Association of Midwives Newfoundland and Labrador said she became a midwife because it combined her interests in reproductive health, primary care and education in one profession.
"It's probably one of the most profound moments in a person's life, giving birth," she said. "It's so rewarding to watch parents, you know, be born, essentially."
Advocates have also pointed out that midwives are able to provide patients with continuity of care they can't always get from physicians, who have a higher volume of patients.
"You are available 24/7 by pager for emergencies, you know? We keep people out of the hospital," Thompson said.
Thompson is looking for the government to fill the provincial chief midwifery role, which she said has been vacant for over a year. The Health Department says that process is in its final stages, and a new provincial chief midwife will be announced in the coming weeks.
"The provincial chief midwife will work closely with Central Health and the Gander midwives as they will continue to provide leadership and guidance as the practice matures and access improves," said the statement.
Kristina Denny said she would have liked to avail of midwifery services while pregnant with her newborn son but wasn't able to because she lives in Corner Brook, which falls under Western Health.
Denny said her great-great-grandmother, Susannah Eveleigh, was a midwife in Hampden, at the base of Newfoundland's Northern Peninsula. Denny said her grandmother travelled between communities by boat and dogsled, and attended about 2,000 births.
"She had no medical training. It was just she's the only one there that took that role on," Denny said. "And she did it. It's pretty cool."
Denny previously used a midwife while pregnant with her daughter, Eveleigh, in Ontario.
"[I saw] her my whole pregnancy, so she knew who I was, she knew my family, she knew me and just, like, a really close connection and it made a difference," she said.
That option wasn't available this time.
"It was really difficult to be here when I got pregnant," she said.
Denny wanted to have a home birth but didn't feel that option would be safe without a registered midwife present.
Maguire said Birth Justice N.L. is hosting an online rally Saturday for people across the province who would like to see increased access to midwifery care.
"Families have been advocating for this since, you know, the '90s," she said. "It's really time for the government to step up and invest in this really valuable service."