Why one Canadian midwife won't be giving birth at home
A Canadian midwife has helped almost 200 women deliver their babies, but when she gives birth in July, there won't be a midwife by her side. Across the country, the health system is not keeping up with demand
"Midwifery is a part of my history and a part of who I am," Kim Goodman posted on Facebook. "This lack of funding means I am not receiving the care that is so important to me."
Ms Goodman applied for her own midwife in her home province of Alberta as soon as she learned she was pregnant. Within a matter of days, all the practices replied that they were at capacity.
"I always believed that I would have the right to choose the birth environment and care provider that was important to me, especially after helping so many other women achieve those same goals," she said.
"I don't think I've fully accepted the loss even now."
She said she is considered moving to a neighbouring province, or even the US, but says that's highly unlikely given her current health insurance and citizenship.
Midwives provide holistic antenatal care to pregnant woman, generally those with low-risk pregnancies. They attend the birth - often at home or a birthing centre - and help both mother and child in the immediate weeks after birth.
In Canada midwifery is regulated and publicly funded in all but three provinces and one territory.
Policies vary from region to region - in Alberta, the provincial government determines how many midwives and patients can be funded.
In British Columbia, professional approval is up to each regional health authority and midwives must be authorised to access hospitals.
Multiple provinces told the BBC they have wait lists for midwife services.
While there are many types of midwifery in the US, reflecting a variety of training levels, practicing midwifery by those who are not also trained nurses is illegal in many states.
Even so, the practice is growing in the US. The number of births attended by midwives grew from 3.9% in 1990 to 8.1% in 2009, according to the Journal of Midwifery & Women's Health.
In Canada, national statistics on births assisted by a midwife aren't collected. But in Ontario - where the practice has been regulated for more than 20 years - 14% of babies are delivered by midwife.
Since Alberta publicly funded midwives in 2009 the number of available midwives has jumped from 31 to 94.
But that's only a fraction of what's needed to fill demand. Almost a thousand women are on the wait list.
Ms Goodman said midwives build a relationship with mothers, but the word she uses most to describe midwife-assisted births is empowerment.
"The model of care trusts the birth process, believes that a woman has the strength to do it, and that her strength isn't going to run out before the baby comes," Ms Goodman said.
"I think part of the recent resurgence in midwifery is that as people gravitate toward more natural lifestyles."
The restrictions to services are only due to the "fiscal climate in Alberta," a spokesman for Alberta Health Services confirmed. Indeed, provinces across Canada are tighten their belts, which means less funding for midwives.
Tonia Occhionero, the executive director of the Canadian Association of Midwives said there has not been any particular group that has opposed the rise of midwifery, but the wait lists and access would improve with increased advocacy.
She says both consumer groups and women should be "in the streets demanding for more services, which we're not seeing so much of," Ms Occhionero said.
While it's growing in popularity in North America, in many other parts of the world, midwifery is already integrated in the mainstream medical system.
In the UK last year, 55.6% of recorded births were conducted by registered midwives while 39.7% were conducted by a hospital doctor, according to the UK's Health & Social Care Information Centre.
And in late 2014, Britain's National Institute for Health and Care Excellence advised women in the UK with low-risk pregnancies to deliver in a birth centre or at home.
Ms Goodman said as demand for midwives grow, it's valuable to support women in their birthing choices, "realising that there isn't one right way, but that a woman has to feel confident in the choices that she's making and be educated".
"I still have access to medical care, but it's not the model of care that I believe in," she said.
"For me, I want that low-intervention, more natural birth. But in the end, you still end up with a healthy baby, which is obviously the ultimate goal."