New midwifery service poised to launch in Cape Breton
"Increased access to primary care services is needed in most communities, including ours," Egar said.
When Mianh Lamson moved to Cape Breton, N.S., a few years ago, she didn't initially plan to work as a midwife. However, after settling in Inverness, community members kept encouraging her to offer her services.
"We heard a strong desire for better access to women's health care, newborn care, and postpartum support—the type of care that midwives provide," Lamson shared in an interview.
As a registered midwife with 15 years of experience, Lamson found there were no job opportunities for midwives on the island. Nova Scotia’s existing model only supports midwives in three locations: Halifax, Antigonish, and the South Shore.
Lamson initially planned to maintain her practice by traveling across the country for temporary placements to fill vacancies. However, she soon realized the irony of traveling to provide midwifery care while her own neighbors lacked access.
"It dawned on me that it was absurd to drive to Ontario or Quebec to offer care when my neighbor couldn’t access that same care right here," she said.
Starting this fall, Lamson, alongside another midwife, will provide prenatal and postpartum care out of an existing family practice attached to the Inverness community hospital.
They will work collaboratively with doctors, taking referrals and allowing community members to self-refer.
Unlike other midwives in Nova Scotia, they won’t support deliveries due to the distance to the nearest birthing hospitals in Sydney and Antigonish, both over 100 kilometers away.
Lamson expressed hope that one day, childbirth services could return to the Inverness community, a goal she and others are working toward.
Dr. Susie Egar, the physician Lamson approached to start this collaboration, is enthusiastic about the new service.
"Increased access to primary care services is needed in most communities, including ours," Egar said.
In Inverness, five family doctors currently juggle multiple roles, including working in the primary care clinic, keeping the emergency room open, and caring for hospital inpatients. Egar believes the addition of midwives will significantly enhance the clinic's capacity and service to the community.
This new midwifery service is possible due to two recent programs. In 2022, the Midwifery Regulatory Council of Nova Scotia created a pathway for midwives to practice outside the existing sites based on community needs.
The council allows midwives to propose alternative practice arrangements, but funding is not provided, making collaboration with family doctors crucial.
A pilot program launched last year by Doctors Nova Scotia enables midwives to bill doctors, who then bill the province. This program, tied to the current physician agreement expiring in 2027, provides temporary funding for the Inverness midwifery service.
Lamson hopes that by demonstrating the service's positive impact, they can secure more permanent funding before the pilot ends.
Jenny Wright, the executive director of the Midwifery Regulatory Council of Nova Scotia, is thrilled that this initiative is launching in Cape Breton, a region that has been underserved for a long time.
"The midwives will be able to provide extensive care, including prenatal, postnatal, breastfeeding support, and reproductive health, filling a significant gap in the area," Wright said.
While other midwives have expressed interest in setting up similar alternative practice arrangements, funding remains a significant obstacle. Midwives and advocates have long called for the provincial government to increase funding to address long waitlists and expand services across Nova Scotia.
Although the Department of Health and Wellness recently funded two additional midwife positions in Halifax, registered midwife Kalyn Moore sees potential for further growth. Moore, the interim president of the Association of Nova Scotia Midwives, emphasized the high demand for midwifery care, which far exceeds availability in the province.
At the start of 2024, Halifax had a waitlist of 195 people seeking midwifery services. While there are no waitlists on the South Shore and only one or two people waiting in Antigonish each month, the need for midwifery services in other areas remains unmet.
Besides funding, another challenge is recruiting and retaining midwives, with some services previously suspended due to job vacancies. Moore believes allowing midwives to practice to their full scope could help improve recruitment and retention.
Current legislation in Nova Scotia restricts midwives to caring for mothers and babies during pregnancy, labor, and the first six weeks postpartum. Moore argues that midwives are trained to provide a broader range of services, including reproductive and sexual health care throughout a woman's life and care for babies up to their first birthday.
A new law passed last year will enable midwives to practice to their full scope by 2026. Wright believes this change will be beneficial for both midwives and the communities they serve.
Lamson is already envisioning what this change could mean for her practice in Inverness.
"It would really open up possibilities in a profound way," she said.
Lamson is currently practicing this broader scope of care during a temporary placement in northern Quebec, where she provides care to a wide range of patients, from teenagers to older women.
"When you have one central point in the community for all of that care, it creates a relationship of trust. People know they can come to you for anything related to sexual and reproductive health, and that’s really lovely," she said.
