Taxpayers across New Brunswick should be cheering the announcement that four trained midwives will finally be hired by the province – because it’s a smart move financially.
National research shows a planned homebirth, assisted by a trained midwife, can save the healthcare system more than $2,000 per birth. There are roughly 5,000 births in the Horizon Health Network each year (Horizon will oversee the pilot project announced this week); if one-fifth of those were low-risk births that could be assisted by midwives, and one-quarter of those choose home birth, the savings would be at least $500,000 a year.
Start factoring in the cost of hiring midwives at half the cost of physicians to deal with these low-risk births, and the business case becomes more appealing. (The average salary for a midwife runs from $75,000 to $90,000; an average New Brunswick physician’s salary is more than $250,000.) The province says it will spend $650,000 on the pilot project, which sounds like a solid return on investment to me.
What I can’t understand is why it’s taken us so long to get here. Ontario introduced regulated midwifery in 1994. That province has saved at least $70 million since then, based simply on the number of homebirths. Midwife-assisted pregnancies often result in fewer medical interventions and caesarian sections, higher instances of breastfeeding, and lower instances of post-partum depression, all offering more healthcare savings.
New Brunswick is one of the last provinces to regulate midwives. A promise to do so was made in 2008. It took until 2010 to pass the legislation and until 2012 to have regulations approved. A change in government meant a cut to funding, and the promise languished until it appeared again in the provincial budget in February. Now, in December 2016, there is a plan.
Details remain sparse. A job posting for the lead midwife is expected this month. The timeline for the clinic appears to be three to six months into 2017. Mothers should be able to self-refer to the clinic when it does open. There is no cost; you choose a midwife’s care over a physician’s care. (A midwife has a university degree – there are seven Canadian programs of study currently available – and is regulated to provide primary care. A midwife can perform routine assessments, order blood work and ultrasounds, complete deliveries, and offer follow-up care. Midwives also refer cases to physicians if complications or concerns arise.)
Health Minister Victor Boudreau says the province will “see how it goes, what kind of demand there is” and that that province “could possibly expand [the program] down the road.” A good indicator that midwives are wanted in this province is the increasing number of people offering doula services. You can easily find listings for more than a dozen doulas in the province, with a range of backgrounds, services, and fees. Doulas act as advocates for parents, offering their support and information, but are not trained in the same manner as midwives. When the pilot project was first mentioned back in February, a spokesperson with the New Brunswick Midwives Association said they receive requests for services every week. In Canada, 9% of all births are completed with the help of a midwife. Another indication of success would be that there are now more than 700 midwives practicing in Ontario; more than a few of whom are displaced Maritimers waiting for a chance at a job back home.
There is great power in making small changes. Introducing midwifery into the healthcare options for New Brunswickers might not tackle a huge portion of our soaring costs, but if we continue to adopt small, but significant changes, big things could happen.