N.W.T. residents protest against planned midwifery budget cuts

Residents gathered outside the Legislative Assembly on Thursday to rally against the Northwest Territories government's proposed funding cut for midwifery services.

The 2024-25 budget being proposed by cabinet includes $48.4 million in reductions across departments. The Midwives Association of the Northwest Territories says a proposed cut of close to a million dollars would otherwise fund almost half of all midwifery positions in the territory.

The association says the cuts affect four practitioner positions servicing Yellowknife, Behchokǫ̀, Dettah and Ndılǫ, a territorial manager's position, and a senior midwifery consultant within the Department of Health and Social Services.

Lana de Bastiani, who has spent years seeking fertility treatments to start a family, attended Thursday's protest. She said doing so had cost roughly $20,000, besides travel and accommodation, to seek services down south – "completely all out of pocket."

"I have travelled at least seven times since December, multiple trips, weeks off work, flights, accommodation – all of this just to try to get pregnant. And now, whenever hopefully I do get pregnant, there are planned cuts to remove the support that I will need to help carry a healthy pregnancy and deliver," she said.

Next week, De Bastiani hopes a petition will be tabled in the legislature. She called the GNWT's decision "heartbreaking" for Yellowknife as "we are the benchmark of what gets set across the territory."

Fort Smith became the first N.W.T. community to have a midwifery program, followed by Hay River. In the legislature on Tuesday, health minister Lesa Semmler said that is where the focus must remain.

"Right now, we are barely filling those positions in those two communities, where there are no prenatal services and no other services," Semmler said.

"This is where we need to focus on midwifery, because midwifery is to be able to birth closer to home with your family and those people in those communities. That is where we want to make sure these programs are successful."

Asked by Yellowknife Centre MLA Robert Hawkins if investment in the territorial capital could support people in smaller communities, Semmler said: "The more support I put in Yellowknife, the less people I'm going to have working in the front line that are actually doing the midwifery program.

"If we keep taking away and we put it in Yellowknife, then that's going to be taking away positions or midwives that could be working in those communities."

Hawkins, who was present at Thursday's rally, said he's working with other MLAs to turn the proposed funding cut around. His main concern, he said, was the absence of consultation with a territorial advisory committee on midwifery.

"Maybe they should have scratched below the surface, saying, well, it's not filled because they don't advertise, they don't hire people," Hawkins said.

He said continuing to fund midwifery as earlier planned "saves the government overall money" in terms of the service offered and the relief afforded to other services.

"We're getting amazing service, amazing value for what they do. Why they're not supporting it? I have no idea," Hawkins said.

Range Lake MLA Kieron Testart said cuts in Yellowknife meant midwifery in the N.W.T. would "lose that core centre of support that will allow it to grow and succeed in other communities."

"We need the whole system working. We can't take it away from the centre," he said.

Zoe Guile, a student midwife who grew up in Yellowknife, said she wants to work in the city. She stressed midwifery is necessary healthcare that supports the mental and physical health of pregnant people, while being crucial to social and cultural well-being.

"If you ask the people who are looking for midwifery services, they'll tell you that it's not an extra," Guile said.

"If we have the chance to have a conversation with cabinet and the people who made this decision, they would learn a lot and be able to come to the understanding as well that this isn't just an extra – even for the people in Yellowknife."

Another student, Gabby Lamarche, said she has always wanted to be a midwife.

"We are incredibly honoured to be using our voices, joining the long line of midwives that have been doing this work," Lamarche said.

"It's a service that can help fill a lot of gaps. It can help reduce barriers to care and also [offer] cost-effective healthcare service delivery ... that will help open up more funds to be used in other aspects of the healthcare system."

Treiva Plamondon, of the Northern Birthwork Collective, said residents from many small communities are sent to Yellowknife to access healthcare services. Plamondon argued that locum healthcare professionals often aren't able to build connections with residents who travel from outside the city.

"They're often tossed around between providers, which isn't fair when you're trying to get the best care that you can," Plamondon said. "Midwives are essential to reproductive healthcare, they are the backbone to everything."

Continuity of care

A rally was held in Fort Smith on the same day, where attendees reported a turnout of roughly 45 people.

"They remember what the fight was like to get midwifery services in Fort Smith," said Lesley Paulette, a spokesperson for the midwives' association.

"There are other ways to do cost savings in healthcare, but cutting an essential service like midwifery is not the way.

"There are some people in Yellowknife who say, 'I wished I'd been able to have midwifery care when I transferred from Fort Smith to Yellowknife, but it just wasn't an option.' ... People in Yellowknife have been asking for services for almost as long as people in Fort Smith had been asking for services."

Paulette emphasized the importance of continuity of care and for healthcare professionals to build a relationship with locals. She said it's also crucial for Indigenous people to access culturally safe care.

"It's really quite distinct from the kind of care that one can get from a western medical model ... Indigenous communities, more and more, are looking for the renewal of midwifery as part of restoring balance in their communities and in their families," she said.

"People are beginning to recognize that losing that tradition has resulted in great loss for families and communities. It's time to to renew that tradition ... It's very disappointing to those of us who are really looking forward to developing a pathway for northern and Indigenous midwifery education.

"It's very disappointing for us to think that there will no longer be that core group or nest of midwives in Yellowknife who can really help to support that."

Returning to the subject in the legislature on Wednesday, Semmler – who was a labour and delivery nurse – said the territory needs "a birthing service that is going to be staffed," suggesting the health authority was having a hard time meeting that goal.

"Expanding midwifery is an extra in Yellowknife. It's not an extra in Fort Smith and it's not an extra in Hay River," she said.

"Right now, we're having a hard time even keeping those positions filled, so we need to focus where there's no birthing services. And that's what I'm doing, and that's what I'm committed to doing."

Aastha Sethi, Local Journalism Initiative Reporter, Cabin Radio