Consumers Supporting Midwifery Care

Anne Duggan
The Ottawa Citizen
November 18, 2003

Dr. Carl Nimrod said the reduction in midwives at the hospital was done to cut costs.
CREDIT: Paul Latour, The Ottawa Citizen

The Ottawa Hospital is reducing the number of midwives it allows to use its facilities, further frustrating pregnant women who already battle long waiting lists to find a midwife.

As a cost-saving measure, the hospital decided not to renew temporary
privileges for three of its 15 licensed midwives after being told by
the provincial government to review the hospital’s priorities, said
Dr. Carl Nimrod, chief of obstetrics at the Ottawa Hospital. The
privileges will expire in April.

Midwives are angry and concerned because, they argue, other Ottawa
hospitals are not willing to pick up the slack. Already, Ottawa’s two
midwifery practices — the Midwifery Collective and the Midwifery
Group — put about 20 women on waiting lists every month and turn
away even more outright. Most of the women on the waiting list don’t
get a midwife available in time to deal with their pregnancy.

Shannon Smith, an Ottawa woman who has had midwifery care, leads a
lobby group that warns the Ottawa Hospital move will make it
increasingly difficult to get access to midwives.

“The challenge will be to get everyone around a table to talk about
this,” said Ms. Smith, of Consumers Supporting Midwifery Care. “One
hospital can’t just decide to not have midwife-attended births until
the other hospitals agree to handle the cases.”

Dr. Nimrod said that as a tertiary-care facility, the Ottawa Hospital
has made high-risk births — ones attended by doctors, not midwives —
one of its priorities.

“The Ottawa Hospital has more midwives than all of the regional
hospitals put together,” he said. “What we are trying to do is to
redirect these cases, especially to our community partners.”

In 1994, provincial legislation made midwifery care fully funded by
the province. Midwives are considered primary caregivers in low-risk
births. This year, the province anticipates 7,000 midwife-attended
births in 56 Ontario hospitals. Last year in Ottawa, there were 278
births attended by midwives.

According to Dr. Nimrod, low-risk births at the tertiary-care
hospital cost $1,000 more than if they occur in a regional hospital.

Dr. Nimrod would not disclose the total number of low-risk births he
expects to be moved to the Queensway-Carleton Hospital and the
Montfort Hospital, saying that decision will be made in March.

But a spokeswoman for the Queensway-Carleton told the Citizen there
are no plans to expand its midwife program. The hospital has four
midwives, and the program will remain “as status quo,” said Judy
Brown, director of communications.

The Montfort Hospital, which currently has no midwives, has agreed to
give them hospital privileges.

But hospital staff and the midwives have been unable to agree on the
extent of care a midwife would be able to provide to a client once
they enter hospital.

“They are offering us a very, very confined scope of practice. We
would be transferring care for nearly 90 per cent of our low-risk
births,” said midwife Agnes FitzGerald.

The document Montfort Hospital: Politics and Procedures was given to
the midwives by the Montfort and requires a mandatory transfer of
patient care to a doctor for more than half of the listed symptoms
that can occur during labour. The Ontario College of Midwives only
requires a consultation with a physician for these same symptoms.

Midwives believe that transferring the care of their clients would be
professionally frustrating and expensive for Ontario taxpayers.

“Midwives are paid for a full course of care and physicians are paid
per service,” explained Ms. FitzGerald. “This would be a duplication
of fees.”

When Sarah Doyle’s temporary hospital privileges run out next spring,
she will be forced to leave Ottawa, she says. But the recent graduate
of the four-year midwifery program at Laurentian University said: “I
have hope that this will be resolved. Maybe another extension with
the Ottawa Hospital, but that is looking grim. Maybe something
permanent with the Montfort.”

© The Ottawa Citizen 2003