Friday April 7, 2023 | VICTORIA, BC [Updated April 8, 2023]
by Mary P Brooke, B.Sc. | Island Social Trends
All registered midwives in BC are independent practitioners. But nearly 70% of them choose to operate in team-based scenarios.
That’s largely due to the business model which is much like the small-business-owner operational model that family doctors have been following for years.
As seen across BC, the independent family physician business model has let to a problem with doctors eventually retiring and leaving many patients without a primary caregiver.
And much like with family doctors, midwives find the work-life balance a little easier to manage when not all activity of the patient roster is entirely on one person’s shoulders. As well, in a team-based situation there is the opportunity to share ideas, resources and professional advice.
Currently 438 actively registered midwives:
There are about 525 registered midwives in BC at this time. Of those, about 438 midwives are actively registered with the Midwives Association of British Columbia (MABC) and practicing in about 101 locations; the rest are students and midwives who operate in “some additional categories”, says a spokesperson for MABC.
All practicing midwives in the province are MABC members, as the association has negotiated access to insurance coverage and the MPP (midwives protection program).
In a survey undertaken by MABC in May 2022 (survey size 229), 69.87% of midwives in BC practice in team-based scenarios, with 15.28% operating solo, and 14.85% in an alternative way.
Currently in negotiations:
The MABC is currently in contract negotiations with the Ministry of Health on the Midwifery Service Agreement (MSA) 2022-2025, according to MABC Board Co-Chair Lehe Spiegelman. In December 2021, after two years of negotiation and arbitration, MABC was presented with their final arbitration results for the MSA period 2019-2022.
Priorities for the current contract negotiations include:
- flexible payment models;
- fair remuneration; and
- compensation for critical infrastructural support.
Further, MABC is considering critical retention and recruitment strategies to promote a stable and growing midwifery profession in the province.
A key health service:
A recent study by UBC researcher Dr. Kathrin Stoll shows that BC midwives are providing safe primary care for pregnancies of all medical risk levels, contrary to a popular belief that midwives mostly manage low-risk pregnancies.
Midwives attend to pregnant mothers before, during and after the birth.
Knowing this, more pregnant women and families may choose to include a midwife in their care team through a pregnancy.
Importantly, midwifery continues on past the delivery of the baby, including care of the mother and family’s well being such as breastfeeding and family support tips. Very often that takes place in the family’s home situation or with visits to the midwife’s local clinic or office.
April is International Caesarean Awareness Month. MABC is promoting that clients of BC midwives have lower rates of cesarean deliveries compared with clients who had a physician as a ‘most responsible provider’ (regulated healthcare professional who has overall responsibility for directing and coordinating the care and management of a patient at a specific point in time).
Fewer C-sections where midwife assists:
According to a midwifery report by Perinatal Services of BC about deliveries in BC during 2014-2016:
- The highest percentage of midwife-involved births (35%) were on Vancouver Island.
- There were 42% fewer caesarean births (than the provincial average) when a midwife assisted.
- Midwives were involved in 21% of total pregnancies in BC.
Training more:
BC Health Minister Adrian Dix announced last month that more midwifery training seats will be funded at the University of British Columbia (UBC), to help boost the number of midwife practitioners in this province. The February 17 announcement said the 20 new seats would increase the annual intake at the UBC Faculty of Medicine Midwifery Program to 48.
That would also increase MABC membership as they continue to address recruitment and retention.
“We’re thankful to the government and this investment in the future of midwifery is very promising,” says Tobi Reid, Registered Midwife, Cook Street Community Midwives who is also a MABC Board Member.
“We’re so pleased to see progress being made in recruitment, and we also look forward to seeing continued work on retention and addressing sustainability of the profession for existing registered midwives,” says Reid.
“This will ensure continued availability of clinical preceptors and learning environments for new midwifery students. We know that further investment is needed in compensation and infrastructure support and look forward to seeing what’s ahead as the Midwives Association of British Columbia continues its work with government.”
Most midwives join an existing practice:
Midwives can join the profession and can enter into practice in a variety of ways, such as working as solo practitioners, joining a team of existing midwives, or joining an inter-professional practice.
The cost/overhead of running one’s own practice can be an impediment to women joining the midwifery profession. An internal survey by MABC shows that about 30% of a registered midwife’s MSP-earning is going towards the ‘business of midwifery’.
Costs include office/clinic overhead, vehicle costs, professional fees and other expenses to support their service offering “whether they were a practice owner or not”.
“Most midwives don’t run their own practice and choose to join an existing practice. The costs of running a practice are a barrier to the business owner, but also to the midwives working from the clinic as higher operational costs result in higher overhead,” says MABC board co-chair Lehe Spiegelman.
Further directions:
Similar to physicians, there continues to be a need for operational overhead cost support, and so MABC continues to discuss their payment model with the BC government.
“Administrative costs for clinics are not covered and come from their own pockets. Rent and overhead costs for clinic spaces continue to increase,” says MABC.
According to the Perinatal Services of BC report, increasing midwife-assisted births would result in significant health-care system savings. At a time when health-care funding must be applied even more carefully than ever, this direction in maternal health-care would be an important consideration.
The Ministry of Health has stated this week that they aim to adopt standards for maternity care; this was said in a nursing context but midwives fall with the BC College of Nurses and Midwives and as such might expect a similar approach to adopting standards.
About MABC:
The MABC Board of Directors is composed of at least six elected members and one student representative, and meets eight times per year. The Board and committees meet regularly.
The current MABC Board of Directors for 2022-2023 is co-chaired by Lehe Spiegelman and Lisa Delorme. Treasurer is Cindy Storie-Soth. Members at large: Jennifer Nguyen (Vancouver Coastal Health Authority), Emma Butt (Vancouver Coastal and Fraser Health Authority), Yarra Vostrcil (Island Health Authority), Tobi Red (Island Health Authority), and Adrienne Carruthers (Island Health Authority). Student rep: Sandy Chen.
=====RELATED:
More midwifery training seats at UBC (April 17, 2023)
First new medical school in western Canada in over 50 years (Nov 28, 2022)
More internationally trained doctors coming onstream in BC (Nov 27, 2022)
===== ABOUT THE WRITER & ISLAND SOCIAL TRENDS:
Mary P Brooke is the editor and publisher of Island Social Trends as published daily at islandsocialtrends.ca.
She has been covering politics, business, education and communities through a socioeconomic lens since 2008 on south Vancouver Island (previously as West Shore Voice News, and before that both Sooke Voice News and MapleLine Magazine).
Ms Brooke followed and wrote extensively about the COVID pandemic during 2020-2022. Among other qualifications, Ms Brooke holds a health sciences B.Sc.
Mary P Brooke now reports with the BC Legislative Press Gallery.
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