Midwives across British Columbia have been without a contract for nearly four months and are now challenging Premier Christy Clark's "Families First" pledge, saying Wednesday that they will immediately stop training students and could withdraw their services within 90 days.
Although the province spends only a few million dollars out of a $17-billion health budget on midwifery, it has grown quickly since the practice was first regulated in B.C. in 1998. One in six births in the province are now supervised by one of B.C.'s 220 midwives.
Negotiations since March 31 for a new contract have not gone well. The Midwives Association of British Columbia is calling for a $3-million annual investment over the next five years to allow the program to grow, especially in rural areas.
During the 2013 election campaign, Ms. Clark pledged to invest in health care, education and tax cuts to help families in the province. The faceoff with midwives flies in the face of those priorities, the midwives say.
According to executive director Ganga Jolicoeur, the association's plan would see midwives supervising over a third of the province's births by the end of the decade. With the clients of midwives spending less time in hospitals and requiring fewer invasive procedures, the association says the province could save $60-million by 2020.
However, Ms. Jolicoeur says her group's proposal has not met a warm reception. "We are very, very far apart," she said of negotiations.
"Now we feel as though our backs are up against the wall."
Having used the services of a midwife herself over a decade ago, Ms. Jolicoeur says the caregivers often form a lasting bond with families. Midwives are often on call 24/7 to answer questions from nervous mothers-to-be, and meet with families for as many as six weeks after the birth of a child.
While some mothers choose home births with midwives, the vast majority still elect to go to hospitals. The use of midwives is still a novelty in North America. However, their use is standard in many European countries, with midwives supervising up to 70 per cent of English births.
According to B.C. Health Minister Terry Lake's office, the proposals from the midwives have so far fallen outside of the government's "bargaining mandate." In recent negotiations with public workers, Ms. Clark's government has taken a hard line on increased spending due to the province's razor-thin budget surplus.
"The ministry is still hopeful that we can come to an agreement that keeps our province's health care system financially responsible and sustainable while providing quality care to new parents and babies," the minister's office said in a statement.
Despite the current labour dispute, the work situation for midwives has improved over the past decade. Where midwives may have once been seen as a nuisance, Jane Wine says many hospitals now see midwives as an important part of the birthing process.
"It's worrying that the government isn't recognizing the work that midwives are doing across the province," said Ms. Wine, who works at a practice in the Lower Mainland. "There is an acceptance now that we are part of the care system."
A fourth-year student from the University of British Columbia's midwifery program was supposed to work with Ms. Wine and her colleagues as of September. Working alongside volunteer midwives, students learn how to find a baby's position and look for heart rates as part of a hands-on component of their program. As of Wednesday, participation in the UBC program is on hold.
"That makes me incredibly sad. I'm committed to the UBC program, this is a small community, we know these students, but we need to do this," said Ms. Wine.