Do you have the ability to order labs, ultrasounds and prescribe medications?
Yes. I have access to and am trained to utilize technology, medical equipment, medications and offer to order and interpret lab results and order ultrasounds when requested by the families that I work with. Ultrasounds, lab tests and other technology offer different kinds of information and have their own risks and benefits. While these tests alone can never give us a 100% full and complete picture of any situation, they can provide information that can be useful when making decisions.
Are your midwifery services funded through AHS?
Yes. I am currently providing publicly funded midwifery services through Prairie Midwives, who are funded through Alberta Health Services.
Do you have hospital privileges?
Yes. I have hospital privileges in my community.
Do you attend planned hospital births?
I do attend hospital births, however I primarily work with families who are planning to give birth at home or at the birth suite, as community birth options are very limited and families who want to give birth at home often have a very hard time finding a care provider. I mainly utilize my hospital privileges for times when concerns arise during pregnancy, labour or birth where hospital birth may be recommended. If hospital birth, or hospital based interventions become necessary, I am able to transfer in with families from home to hospital, and can continue to provide midwifery care, so that families do not lose their midwife if unexpected events occur during their pregnancy or birth process.
Families who know they will want to access routine hospital based interventions such as routine induction or routine epidurals have access to a wide variety of caregivers. I’m happy to provide referrals to colleagues in the community who provide more medicalized care, who will likely be a better fit.
Do you recommend routine induction of labour for going past the due date?
In our current birth culture, routine induction of labour before, or after the due date has become a standard expectation for families and caregivers alike, despite the fact that healthy babies may come anytime between 37-42 weeks and that pregnancy length varies from person to person depending on many factors, including family history and differences in each individual pregnancy. While we have access to technology such as ultrasound, which provides the most accurate means for pregnancy dating that we have available, the exact day that a baby “should” be born remains unclear.
I am trained and skilled in managing medical inductions of labour as part of the midwifery scope of practice, however induction of labour is a major intervention associated with an increase in potential complications for both the birthing parent and baby including an increase in cesarean section, especially for people having their first baby. As the families that I work with are often looking to avoid routine intervention, I am very comfortable with supporting a wide variety of pregnancy lengths and am not asked to participate in routine induction of labour for going past the due date very often.
Do you perform medical interventions during pregnancy, labour or birth?
Many families are concerned about avoiding unnecessary medical interventions during pregnancy, labour and birth, due to increased social awareness and criticism around the hyper-medicalization of birth within western maternity care systems. Over the years, researchers, care providers, birth advocacy and human rights groups have raised concerns around rising induction and cesarean section rates, iatrogenic harm (complications that are caused by an intervention, that then require more interventions to treat) and increased rates of birth trauma experienced by pregnant people who report that they did not feel listened to or that they experienced coercive counselling from their caregiver and were not supported to make informed decisions around interventions that occurred during their births.
Interventions can include seemingly insignificant procedures such as vaginal exams, breaking the waters and continuous fetal monitoring, or they can be more invasive procedures such as inducing or augmenting labour with medication, cutting an episiotomy or performing a cesarean section.
Interventions are not inherently good or bad by themselves – their value depends on the context of the situation, and the values of the birthing family. The hoped for benefit behind every intervention is to increase the likelihood of a healthy outcome, while minimizing the chance of harm to the pregnant person, their baby, or both. However, despite good intentions, interventions also come with risks and potential consequences that need to be fully communicated to birthing families so that families can make informed choices that are best for them. Well placed interventions have the potential to be life saving, however when used routinely, often increase risk of complications without improving outcomes.
Whether or not a person considers an intervention necessary or unnecessary depends on their own philosophies and understanding of normal birth, the kinds of births they are used to seeing or supporting, the politics and cultural norms in their area, and their own understanding of the situation.
I am trained and skilled in performing a wide variety of medical interventions, however I do not routinely intervene at births, and only perform interventions after a full informed choice discussion if the birthing person accepts both the benefits and risks and has decided that the intervention is in their best interest.
How do you support long labours?
I am very comfortable supporting longer, physiologic labours and births (especially for first time parents), and find that people cope with the intensity of labour best when they are well supported in their own space, have access to their own food and drink, can rest in the privacy fo their own home, and have access to reassurance and care that reaffirms the normalcy of the situation. Natural pain relief during normal birth might include deep breathing, physical support from your partner or doula, water immersion, massage, counter pressure, and unrestricted movement.
What if I need an epidural?
It has been my experience that when birthing people are experiencing a normal labour, are well supported, have access to freedom of movement, feel private and safe in their own homes and are unhindered to behave how they need to throughout their labour, that epidurals and other pharmaceutical pain medications are accessed much less frequently.
Epidurals are most commonly accessed during planned hospital births, or when labour has not progressed normally due to baby being in an extra challenging position or when the birthing person has become absolutely exhausted. In these extra challenging circumstances, compassionate use of pain medication may absolutely be the next right choice, if the birthing person decides it is.
As I have hospital privileges, if an epidural is decided on, I am able to call the hospital and request they get a room ready for us. Once we arrive at the hospital, I consult the anesthesiologist, who is the specialist who places the epidural. Once the epidural is in place and working well, I manage the epidural, provide the extra necessary monitoring and medical tasks, and continue to provide midwifery care in the hospital setting.
Do you recommend birthworkers or doulas?
I highly recommend that families consider hiring a doula or birthworker if they are able to, especially for first labours, which are often longer and often require more support for both the birthing person and their partner. As a midwife (and former birth doula/holistic birth consultant), I know the difference that having doula support makes, even when you have a supportive partner and align well with your midwife.