Pregnant women are scrambling after the last midwife at Nova Scotia's main maternity hospital went on leave, putting the midwifery program on hold and raising questions about the province's approach to childbirth.
The IWK hospital in Halifax was able to hire four midwives under legislation that kicked in early in 2009. But their ranks were whittled away over the past year by terminations, resignations and now an unspecified leave for the final midwife. There are none left.
"It seems like a total mess, no one seems to know what's going on," said Ali Shaver, 31, who is expecting her first child within days.
She said she got a letter a little more than a week ago, telling her there would be no midwife services at the time she was due and urging her to call her family doctor. But she didn't have one and was worried about resigning herself to the "crapshoot" of a random doctor at the hospital, someone whose birthing philosophy she would not know and with whom she'd have no relationship.
On Wednesday, Ms. Shaver found a doctor with whom she was comfortable at a clinic near her home. But she's concerned about the difficult position other women are still facing.
"Their choices no longer exist and they've been forced into a corner," she said. "It's kind of an archaic approach to women's health and I can't believe this has happened."
The current disquiet is in sharp contrast to cautious optimism heard when the former government brought in legislation to regulate midwifery, a tradition with deep roots in Nova Scotia. Prior to these rules, the practice was in a legal grey zone and the regulations allowed for a total of seven midwives to be hired in three spots, including the IWK.
The hospital is hoping to refill its positions and recently posted the vacancies.
"I really do believe fundamentally that working collaboratively and together is very possible and [has]every possibility of being successful," said Jocelyn Vine, vice-president of patient care at the IWK. "We are very much committed to working with the model that is here in the province."
But to some, the institution is part of the problem. The province's other midwives are in smaller centres while at the IWK the practitioners were four people among thousands working at a tertiary care hospital. Critics say they were in an impossible situation as employees of the hospital, under the supervision of regular birth managers, instead of having visiting privileges.
And two of the former midwives allege a toxic environment at the IWK.
"I never anticipated the level of venom," said Karen Robb, who now lives in Alaska.
A veteran midwife who has also worked in Britain, she was fired from the IWK late in 2009. The hospital won't discuss personnel issues and Ms. Robb said her termination came after a complaint for which she was subsequently cleared. She is now studying nursing and is volunteering at Covenant House, she said, having been soured on midwifery by her experience at the IWK.
She described a "clash of belief systems" and said there was strong pressure on midwives to assimilate into the hospital's way of doing things.
"There was a small group of nurses and doctors that really felt put out that the province felt they needed another provider," Ms. Robb said. "They made it uncomfortable and were not reined in."
Ms. Vine said that she had heard no harassment concerns and pointed to the institution's employee-protection policies. But she made no apologies for midwives having to fit in.
"I think that when you're hired within an organization … that kind of assimilation to the organization and the culture and the expectations, the quality and safety standards, wouldn't be considered unusual," she said.
Another former midwife, Rachel Godwin, had listed problems ranging from the province's regulatory system, which farms out complaints to practitioners in other provinces who aren't employees of hospitals, to the "insane pecking order" among midwives in Nova Scotia. And she said that the manager of the IWK birth unit, who has since been transferred, was antagonistic.
A veteran of midwifery in Britain and New Zealand, Ms. Godwin left the IWK last month and is now setting up a business. She said her departure was because a more senior midwife would no longer continue to supervise her work and, as a result, she lost her licence.
She said she understands the pressures the more senior midwife was under but saw the decision as a way to get rid of her.
Both the manager and the more senior midwife, who is on leave, still work at the IWK. The hospital does not permit employees to speak to the media without approval from public relations staff and turned down the chance to have these women respond to the allegations.
The situation at the IWK has added urgency to a government review of midwifery currently under way. The review has been delayed several times and Health Minister Maureen MacDonald said it is now expected "fairly early" in the new year. She acknowledged difficulties in the midwifery program but said that they were not insurmountable.
"I think we have to put the problem in perspective," she said. "It is a very new program. It's going through some growing pains."
Ms. MacDonald said she saw no practical reason why a midwifery program shouldn't be attached to the IWK. But she acknowledged the question of how best to structure the employment model and said staff are looking at how midwifery is done in other jurisdictions.
The review will land in a heated climate, with detractors of the current system of regulation increasingly vocal. Criticism has focused on access to midwives and the availability of home-birth options.
"Things have to change, that seems clear," said Erin Hemmens, co-chair of the Midwifery Coalition of Nova Scotia. "It hasn't worked."
With legislation allowing for midwives in only three sites, the result is that people in large swathes of the province have no practical access to midwifery. And since two midwives are required for a home birth, the small number hired under the legislation means these types of deliveries have been very limited.
"My choices are to go to a hospital or have a birth at home, unassisted," said Erica deSousa, who lives in the Gaspereau Valley and had her first child with an unregulated midwife before legislation kicked in.
"If [legislation]is about public safety and all of a sudden I'm considering that as an option, that doesn't meet the goal," she added. "I don't think hospital births are wrong or people shouldn't have them. But given the choice, I wouldn't do it."