Funding cap prevents Alberta midwives from delivering services, and babies

EDMONTON – The province’s 95 midwives are increasingly forced to turn away potential clients because Alberta Health Services is refusing to boost funding for their services.

The first official funding contract between AHS and the Alberta Association of Midwives, a $37-million, three-year pact, expired last week.

“Until the price of oil dropped, we thought we would get an increase because we have gotten an increase each year,” says JoanMargaret Laine, president of the midwives association. “It’s very distressing. As a practicing midwife, it’s difficult to tell women no, and read their stories and for them not to have the option.”

Midwives are paid $4,600 to deliver a “course of care,” the term used to describe the suite of pre- and post-natal services provided to a pregnant woman. Most births guided by a midwife are done at home or in a private birthing facility such as the Lucina Centre, though women can also choose to go to a hospital. Midwives are generally recommended only for low-risk pregnancies, but they sometimes consult on high-risk cases.

Under the deal with AHS, individual midwives are limited to a maximum of 40 courses of care per year. The health authority also puts a cap on the total courses of care funded around the province. For 2014-15, that cap was set at 2,374. AHS is extending current funding another year while negotiations continue toward a new deal, but the health authority is so far holding firm to the maximum of 2,374.

That total doesn’t come close to allowing all midwives to reach their maximum of 40 courses. Nor does it provide any courses for new midwives who might want to move to Alberta, or a cohort of students set to graduate this spring from Mount Royal University in Calgary.

With Alberta continually setting records for births in recent years — an estimated 54,000 to 56,000 babies were born in 2014 — demand for midwifery services has been climbing.

As of last fall, the wait list for a midwife stood at around 800 women in Calgary, Edmonton and Red Deer, Laine says, though she believes the real number is much higher across Alberta. She says there are several places in the province, such as Grande Prairie, that have no access to midwifery because the existing courses of care are being used up in bigger centres.

Still, Laine says she is optimistic AHS and the province will eventually come through with an increase in courses.

Joanna Greenhalgh, one of Alberta’s registered midwives, has assisted with more than 1,000 births over a long career. The 62-year-old Edmontonian hosts group sessions for moms-to-be who are all due the same month. She can order tests and provide advice on sleep habits. When it’s time to deliver, she’s there to guide the process. And afterwards, she’ll offer assistance with breastfeeding.

“We talk about common complaints, like interrupted sleep, fatigue, nausea. And we talk about fears,” Greenhalgh says. “It’s really important people feel listened to. There is nothing that is a silly question.”

Greenhalgh believes the key is to educate the public and the government on the benefits of expanding the profession. From a basic financial perspective, more women having babies outside the hospital means less cost for doctors, nurses, beds, and drugs, she says.

AHS issued a statement on the issue, saying that although midwives are a valued part of the health system, the fiscal struggles in Alberta “have an impact on how much funding various programs or services receive.”

The AHS stance comes at a time when the cash-strapped provincial government has decided to cut overall health spending. But critics say it also reflects a persistent belief that midwifery is an elective, optional service rather than a mainstream, essential part of the health system. The results of funding limitations, they say, are long wait lists, women denied choice, entire regions of the province left without any midwives, and ultimately increased costs for the health system.

“At times of governmental cuts, choice is the first thing to go,” says Dana Weatherhead of the Association for Safe Alternatives in Childbirth, an advocacy group that promotes options for maternity care. “But we also know there is a strain on the health system, and if we better utilize midwives … that can actually save money.”

Weatherhead’s organization is pushing for an end to the cap and a change to the funding model so that “the money follows the baby.” This would mean that regardless of whether a woman chooses an obstetrician and hospital setting or a midwife and home birth, the practitioner involved can bill the government directly for the service.

It’s a model similar to the systems used in B.C. and Ontario, where midwives are now performing 14 to 18 per cent of births. In Alberta, the rate is about four per cent.

“Right now, lots of women aren’t having the birth they want,” Weatherhead says.

Midwifery in Alberta by the numbers

$4,600: Payment a midwife receives for providing one “course of care” to a pregnant woman, including pre- and post-natal care, labour and birth support, and help with breastfeeding.

2,374: The maximum number of courses of care AHS currently funds for all midwives in Alberta each year.

40: The maximum courses of care each midwife can perform in a single year.

33: The average number of courses of care Alberta midwives perform each year.

38 to 55: Percentage of a midwife’s income that goes to overhead (insurance, professional fees, office costs, mileage, etc.), according to the Alberta Association of Midwives.

95: Midwives currently registered in Alberta.

23: Midwife students set to graduate from Mount Royal University in the next two years.

4.1: Percentage of pregnancies assisted by a midwife in Alberta.

10 to 13: Times a midwife typically visits with a pregnant women before birth.

3 to 5: Times a midwife typically visits with a new mom in the first week after birth.

2009: Year midwifery services became publicly funded in Alberta.

kgerein@edmontonjournal.com