Bringing more midwives into Newfoundland and Labrador's health-care system would not only ease the burden on family physicians, but also give women more options, says Health Minister John Haggie.
But it's taken some time to get the project off the ground.
"One of the challenges has been regulatory. I think another of the challenges has been around simply getting a critical mass of midwives," says Haggie.
The Health and Community Services Department has hired a consultant with what Haggie describes as "extensive experience" setting up midwifery in other provinces, and the program is nearly ready to launch at its first site in the Central Health region.
"We now have three midwives scheduled to start in Gander at the end of this year and we're looking at other sites across the province," Haggie said, adding that his department is in talks with other regions also interested in building a midwifery program.
"We built a foundation and the building is just coming out of the earth to be visible, so we're on our way."
It's a process that hasn't been without its challenges, Haggie said.
"There was a great tradition of midwifery, particularly in Labrador with Grenfell, and that was really derived from midwives who were trained in Ireland and the U.K., but because of changes to the Registered Nurses Act back some years ago this rather precluded midwifery here without stand-alone regulation," Haggie said.
The province brought in midwifery regulations in 2016 and since then, Haggie said, the focus has been figuring out actual staffing and recruitment, as well as working with existing health services to establish a co-operative approach.
"Our idea through the department is to have midwives based both in hospital and in the community so there would be continuity," Haggie said.
A pregnant woman would go and see a midwife for assessment; if she is a low-risk birth, her care would continue to be handled by the midwife, if that's what the woman chose, and stick with that same midwife through postpartum care after delivering the baby.
"I think midwifery will help build a team-based approach to primary care, and the issue then will be when a lady goes to a family physician, is it an issue the midwife can deal with? Or is it something for which the family doctor would be involved?" Haggie said.
"Or maybe even an obstetrician referral. That would be a kind of stepped approach and gives women more choice than they have at the moment."
Foundation set for programs elsewhere
Gander was chosen as the initial starting point for the program, Haggie said, because the women's group there was very outspoken about wanting something in place; a doula who lives in the community has been advocating for midwifery, and the local physicians were also supportive of bringing midwives onto the system.
Haggie said there are already discussions with other regional health authorities for a similar project, once its initial system is up and running in Gander.
"I think the challenge has been to get the first site set up and working properly, and with it breaking new ground that was always going to be a little bit slower," he said.
"Once that site is up and running, I would expect other sites to follow along fairly quickly with a lot shorter lead time."