As the COVID-19 outbreak was reaching its mid-April peak in Nova Scotia, Wendy Thompson was 38 weeks pregnant and walking through the doors of the IWK Health Centre in Halifax. Visitor restrictions meant she had to go alone.
She had long planned to give birth at home with the help of a midwife. But Nova Scotia had suspended midwife-led home births in late March –– the only province to do so for an extended period –– a measure health officials had said was aimed at curbing the spread of the coronavirus.
Thompson's blood pressure had risen that day, and her midwife had recommended she head to the hospital. But unprepared to wait there before being induced, and without her "baby stuff" or her partner, Thompson returned home.
Early the next morning, she unexpectedly gave birth to a healthy girl, Willow, in her apartment bathroom. There was no midwife, only the baby's father, and a doula who was not allowed to assist with the birth.
"That was actually what I'd been longing for, even with a midwife. I would have liked for it to have been as hands-off as possible," Thompson said.
Thompson's dilemma –– choosing between a hospital setting without the support of loved ones, or a home birth without the knowledge and skill of a midwife –– is one that other women no doubt faced this spring.
During the six-week suspension on home births led by regulated midwives, another group of unlicensed practitioners discreetly stepped in to help women wanting to give birth at home.
They were not the midwives regulated by the Midwifery Regulatory Council of Nova Scotia who are employed by the IWK Health Centre and Nova Scotia Health. Regulated midwives are health-care providers who have completed four-year degrees to support all stages of low-risk pregnancies until postpartum care at the six-week mark.
Instead, the group that stepped in are commonly known as traditional midwives, practitioners who do not have a licence or formal training. They work outside of the regulated system and charge a fee for their services. They risk getting fined and/or jailed for medical misconduct.
A traditional midwife based in Halifax said she had around a dozen new clients contact her during the suspension of home births, which is nearly double the clientele she'd get during a normal year.
Mary, whose name CBC has changed to protect from the threat of legal action, isn't sure if this increase was due to the suspension, or due to the care not otherwise offered to the same extent by regulated midwives, such as education and emotional support.
"Maybe they still choose to give birth in the medical system, but they feel abandoned, they feel weird about it, and need to work through it," she said.
Mary works without a licence to better capture what she calls the "folk heart" of midwifery because regulation limits licensed midwives to medical practices and scopes of care.
"[Traditional] midwives are there to offer education on nutrition, a woman's first menstrual cycle, through loss, and death … They're there through birth, of course, but then they're also there through the experience of motherhood," she said.
"They see women grow, and they see those babies grow into adults."
What research says about at-home births
Research from McMaster University has found that using midwives for at-home births in low-risk pregnancies have the same outcomes that similar women have in hospital births. As well, the women are less likely to experience obstetrical intervention, such as caesarean section, and are less likely to suffer third or fourth-degree perineal tear.
The majority of home-to-hospital childbirth transfers in Canada are not emergencies. The two top reasons are requests for pain relief and progression of labour.
Jess works as a traditional birth attendant in Nova Scotia, which involves guiding women and families as they take charge of their childbirth. She doesn't do the same monitoring or assessment that traditional midwives do.
She guided women giving birth at home during the pandemic because she wanted them to have the birth they desired, in a non-clinical setting.
"If they were scared and alone, that would go against why I do what I do," she said.
Due to the legal implications of the work she carried out during the pandemic, CBC is not using her last name.
Jess had around five people interested in home birth contact her during the suspension, compared to her usual two to three clients per year.
Why a birth attendant saw increased demand amid COVID-19
"The people who [were] contacting me, they didn't want a hospital birth before, but with everything going on, it gave them that extra push, like they really don't want one for sure now," Jess said.
Jenny Wright is the registrar and executive director of the Midwifery Regulatory Council of Nova Scotia. She said midwifery registrars across Canada heard from families fearing hospitals due to the pandemic. Wright was pleased the suspension of at-home births was only temporary.
"Anytime that our members are not able to work at the full scope of their practice, and that families are not receiving the full depths of qualified confident midwifery care, we have concerns," she said.
How to get regulated midwifery care in N.S.
In Nova Scotia, a person seeking regulated midwifery care must be living in the Halifax Regional Municipality, Antigonish or the South Shore.
Depending on the client's distance from a catchment area and the amount of demand for midwifery, clients may be denied access to care, which is decided on an individual basis.
CJ Blennerhassett, president of the Association of Nova Scotia Midwives, said practices have always had "long, unfortunate waitlists."
There are 13 midwives providing regulated care in the province –– the highest number of positions ever filled in the province to date –– with an additional three funded positions available.
Would home births be suspended amid another wave of COVID-19?
Dr. Annette Elliot Rose is the vice-president of clinical care and chief nurse executive for the IWK Health Centre.
Asked whether she was concerned women were giving birth with unregulated midwives during the pandemic, Rose said, "I think it's always concerning if people are choosing to experience something and they would like to have health services available to them."
When considering whether to suspend at-home births during the anticipated second COVID-19 wave, she said they will take guidance from the public health department, patients and families, and health officials.
"I would anticipate that we would carry on providing services as long as we possibly can, in many service areas, as we go into a wave two, because we have more information, we have more knowledge, we have more readiness," Rose said.
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