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Midwifery services, at-home birth on the rise in Alliston

Midwifery care and at home-births have increased largely since the onset of COVID-19
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Fewer people are visiting hospitals in-person, including expecting mothers, since the start of the pandemic 

While hospitals follow strict protocols to keep patients and staff safe from COVID-19, much of the public is still trying to limit any perceived sources of exposure to the virus. 

In light of this, midwifery care and at-home births have been increasing in Alliston since COVID-19 was declared a pandemic in mid-March.

"The idea of not going into the hospital for their clinic visits is something that’s very desirable to people right now,” said Holly Ryans, an Alliston-based midwife. 

Midwives are available to mothers with straightforward, low-risk pregnancies and visit them in their home leading up to the delivery of their baby and six weeks postpartum.

During the visits, midwives answer any questions the expecting parents may have and run diagnostic tests that would otherwise be conducted in-hospital.

Midwifery services are fully covered by the Ontario government.

"We would provide all of their labour care, both physical and mental supports,” said Ryans. 

In Alliston, midwives are grouped into teams of three and develop a relationship with families leading up to labour.

“The idea with midwifery care is that there should be continuity of care, so knowing your care provider throughout, feeling comfortable with them and the choice of birthplace,” noted Ryans.

Midwifery rates
Alliston has a high uptake on midwifery services with an average of 40 to 50 per cent parents opting in, compared to the provincial average of just 16 per cent.

“It's an interesting pocket in Ontario where we have such a high proportion that come through the midwifery care, but it's available to anyone who would like it as long as we are not full,” said Ryans. 

She said word of mouth and a positive reputation among Alliston midwives is part of the reason why they have over twice as many births than the rest of the province, but history plays an important role as well.

“With Stevenson Memorial Hospital's labour and delivery unit, there has been a bit of a dynamic history where it has been closed previously because of lack of obstetrician care or lack of the operating rooms being available,” Ryans explained.

“The midwifery care maintained that sort of stable option for people because at the time, they were also offering their services out of the Southlake in Newmarket, so in the times where Stevenson had to close down you could still keep your care provider then deliver at Southlake if needed."

Stevenson has significantly improved its capacity for obstetrician services over the last several years and now has three who work there full-time, keeping it open 24/7.

Benefits
In terms of benefits, expecting parents who use midwives see higher rates of breastfeeding and receive support for it if they’re struggling.

When looking at low risk populations, parents utilizing midwife services also see less c-sections, epidural use and inductions.

"All of those things are still available to clients if needed, but, on the whole, we have lower intervention rates and lower outcomes that way."

Overall, the attentive care, familiarity with the person delivering the baby, advocacy when in hospital and around-the-clock access to medical advice, are all positive factors that attract parents to midwifery services.

Ryans said providing expecting parents with informed choice is another large piece of midwifery care. 

“It’s important that you are not being told what to do in your care, we give you all the information on the risks and benefits,” she said.

"We let you know about the community standards and the recommendations that come from all of the different organizations like society of obstetricians and gynaecologists,” Ryans continued. “Then we support you to follow through with whatever choices make sense for you and your family."

Choice of birthplace, whether at home or in-hospital, is a key component of midwifery as well. 

“Midwives take care of low risk, straightforward pregnancies and deliveries and for that population, the research shows us that home births are a reasonable and safe choice with outcomes that are just as good if not better than hospital outcomes for our carefully selected population,” Ryans explained.

"We carry all the same equipment with us… as you'd initially have at a Level 1 hospital like Stevenson, so we have all of the ability to care for emergencies for Mom and baby in that immediate period,” she continued. 

"If we were having conversations that were running beyond those first steps then we would be moving into hospital at that point."

COVID-19 impact
COVID-19 has impacted the way in which midwife care is delivered in Alliston. There’s always been a “family centred approach” where partners, family members and supportive individuals would be allowed for the prenatal and postpartum visits, but this has been stopped temporarily, Ryans noted.

"We've done our best to kind of Facetime people in for those visits, so they're not missing as much as they otherwise would have been, but it's been a struggle for sure to make that change, when that's something that has been so integral to our care,” she said.

As well, virtual visits instead of in-person ones have risen because of COVID-19.

Fortunately, patients have been mostly very understanding of the pandemic related changes.

Ryans said she’s looking forward to when the pandemic subsides and they can get back to offering the same level of service they did prior.

Anyone interested in utilizing Alliston’s midwife services are urged to call them at 705-435-2406 as soon as they find out they’re pregnant, as they often have waitlists.

- Sam Odrowski, Local Journalism Initiative, New Tecumseth Times




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