Even before Amelia Doran began working as a midwife with British Columbia's Seabird Island Band, would-be clients were knocking at her door.
"Everyone was asking, 'When will you be here?'" said Ms. Doran, referring to the several weeks she spent in the Fraser Valley community last fall. "I had a lot of people asking, 'My baby is due really soon, are you going to be here?' People were really excited."
Ms. Doran was officially hired in January and now has a roster of 10 clients. That is a small caseload by urban clinic standards, but a promising sign for Seabird Island, where health services already include a dental clinic, two maternal support workers and a medical office staffed by two First Nations doctors.
For the band, Ms. Doran is a sought-after recruit who, it is hoped, will bridge the gap between its community doctors – who do not deliver babies – and obstetricians and midwives in nearby Chilliwack. The band's program could also serve as a case study for what advocates hope will become routine: relying more on midwives for maternal care, especially in rural and First Nations communities. The call for more midwives comes as Canada is facing what some have called a maternity-care crisis resulting from several related factors, including a declining number of family physicians who deliver babies and restructuring that has closed hospitals in many communities.
In B.C., midwives have had a growing presence since the province regulated their profession in 1998. They now deliver about 14 per cent of babies born in the province each year, the highest percentage in the country. (Nationally, midwives deliver about 2 per cent of babies each year; in Ontario, the figure is around 10 per cent.) In January, the Midwives Association of B.C. made an ambitious pitch for an even bigger role, calling for support that would result in midwives delivering 35 per cent of babies by 2020.
The MABC estimates its proposal – which involves several recommendations, including provisions for internationally trained midwives to practise in B.C. – would cost about $3-million a year over the next seven years but would pay off in savings of $60-million over the same period and $20-million a year in savings after that. The projected savings would come from shorter hospital stays, fewer caesarean sections and more home births, the MABC says.
Talks about the plan are currently under way between the Ministry of Health and the MABC. If some or all of the investment is approved, it would be the biggest boost for midwifery in the province since 2012, when the province doubled the number of positions at the University of British Columbia's midwifery program from 10 to 20.
In Seabird Island, a recent maternal care review found some women were not getting prenatal care early enough in their pregnancies.
Other problems emerged in the "hand-off" of expectant women from local physicians to doctors in nearby Chilliwack who would deliver their babies. Those problems ranged from missed appointments to hesitancy in communicating health concerns to an unfamiliar practitioner. For the band – a reserve community about a two-hour drive east of Vancouver – a community midwife seemed the obvious solution.
"We dreamed of having a midwife, because that's who we felt was the missing link," said Carolynne Neufeld, Seabird Island's heath director.
Ms. Doran works on contract for the band. Funding for her position comes partly from the province and partly from the federal government.
Clarisse John met Ms. Doran last fall and was the first patient in line when Ms. Doran began her contract in January.
"I can text her," Ms. John, 19, said when asked what she likes about Ms. Doran's approach. "When I have a question, it's easy for me to get in touch with her."
Cori Victor, 18, is expecting her first baby in May and, like Ms. John, jumped at the chance to seek care from a midwife based in her community.
Ms. Doran expects to provide prenatal and postnatal care and education, deliver babies and work with other members of the health-care team to ensure, for example, that children receive appropriate vaccinations at the proper time. She wants to encourage breastfeeding and to ensure that women in the community seek and receive prompt maternity care.
"We are hopefully going to shorten or close that gap from pregnancy to accessing care … in Canada that shouldn't be happening," she said. "We should be able to take care of people when they are pregnant. For me, that's a big goal."