Only one midwife left standing in the IWK midwifery program

HALIFAX, NS – The Midwifery Coalition of Nova Scotia (MCNS) is very concerned about changes occurring in the IWK Midwifery Program. In just one year, the IWK midwifery program has gone from employing four midwives to employing one. The attrition of midwives and the numerous interruptions in services makes it clear that a community-based midwifery program cannot function under the management of a tertiary care hospital whose expertise lies in high-risk hospital-based clients and not in primary health care.

There is presently only one full-time midwife still employed at the IWK Clinic, Kelly Chisholm. The other full-time midwife, Theresa Pickart, tendered her resignation on December 15. As Erin Hemmens, Co-Chair of the MCNS said: “With only one midwife still employed we are not certain what this means for midwifery clients. It is possible for them to still receive care from the remaining midwife, but given the caseload and demands, it is likely that some clients will not be able to remain under midwifery care and most clients will not know whether part of their care including delivery will be handed over to physicians.”

This is only the last of a string of occurrences in the program in this week that have us very concerned. Previous to the resignation of Theresa Pickart, the IWK had told midwifery clients that a registered nurse (Lorraine Jarvie) will now provide care in the midwifery clinic to midwifery clients. She does not have a license for clinical midwifery practice and she has never practiced midwifery in Canada. As a registered nurse, she is required to work under the direction of a midwife or other primary care provider. Moreover, as a member of the IWK midwifery management team, she will need to be ‘supervised’ by her employees (the midwife).

Also, previous to this resignation, the IWK had already informed midwifery clients that they would no longer be allowed to plan homebirths for the foreseeable future. The IWK advised clients that home birth services could not be offered when there are only two midwives employed. However, the South Shore midwifery practice of two midwives have been providing homebirth services all along.

According to Hemmens, “For women under care at the IWK midwifery program it means no end of stress and anxiety. It means, should the last midwife continue to practice, these clients will no longer have the choice to give birth outside of the hospital. Clients will also now receive fragmented care from various providers including nurses and family physicians. We are concerned that this could compromise the quality and safety of care provided.”

There has to be an alternative to this program being managed by the IWK. The alternative must allow midwives to work according to their full scope of practice within a model that provides the best care possible to women and their families. It must allow midwives to be able to use their unique skills and training, in a way that responds to the needs of women and families across this province, who value the different model of care provided by midwives. It must allow midwives to continue to collaborate with other care providers as necessary to ensure that a woman receives the safest care.

A couple of alternatives to the hospital-based program are possible. The Department of Health could allow publicly-funded midwives to practice autonomously. In addition, according to Jane Moloney, Executive Director of the North End Community Health Centre, “the centre has already expressed interest to the Department of Health to be considered as part of the future for midwifery in the province to offer culturally specific, collaborative care that meets the needs of vulnerable and marginalized populations. The Centre now has the space available to work together with midwives, consumers, and the province to consider how to implement that opportunity”.

Women who want to access midwifery care in Halifax deserve answers and they deserve to know what is being done to ensure that they can receive the care they expected to receive under the care of midwives.

For more information and to arrange a media interview, contact Erin Hemmens 422-6429.
Evaluation
MCNS Evaluation report available

Download your own copy of the Midwifery Coaltion of Nova Scotia’s evaluation report:
Uncomfortable Positions: Consumer Comments on Midwifery Implementation in Nova Scotia
and the Appendix of Letters
Position Statement

In response to some issues raised at the Forum, as well as for our own use when speaking with politicians and media, the Midwifery Coalition of Nova Scotia has created a new position statement. It outlines our thoughts and wishes for midwifery in Nova Scotia and we will be using it as the foundation for our lobby efforts in the coming year. Please feel free to cut and paste/draw from for your letters to government officials.

Download it here.
Forum: Finding our Common Voice

We had an amazing turnout for our Forum. Wonderful people with positive energy discussed their personal experiences with and without midwifery. From here we strategize and throw our efforts behind making midiwfery available to all.

If you have some lobbying ideas, ideas about what kind of political action you’d like to see or to take, give us a jingle. mcns at chebucto.org

Also consider coming out to our annual general meeting. We’ll talk about next moves, about what the Coaliton needs to do in order to forward our goals.
Implementation

When the Midwifery Act became effective in March 2009, several things happened:
• Midwifery became a legal, regulated, publicly funded service.
• It became illegal to practice midwifery without a license.
• Midwifery services became available in three model sites—the IWK in HRM; the South Shore DHA; and GASHA (Guysborough, Antigonish, Strait Health Authority.

What this means for women is that some of us have access to publicly funded midwifery care, but many more don’t.

Right now, the Department of Health is evaluating the process of implementing midwifery in the province. Along with this evaluation, the Midwifery Coalition of Nova Scotia (MCNS) has been asked to collect the stories of women and families who live in parts of NS where midwifery services are not available. We have collected these stories and written an analysis which will be available soon here on our website.

We are also meeting to look at the evaluation and consider recommendations.
Our Vision

The Midwifery Coalition believes that midwifery provides the highest standard of care for mothers, babies and families. We believe it is an important part of maternity care and is a choice that should be available to families in Nova Scotia.

We are working to have midwifery accepted as part of Nova Scotia’s health system and to have midwifery care covered by MSI.
The original post can be found at http://mcns.chebucto.org/

I used 3.75 mm double pointed needles, and yarn that called for about that size needle. I haven’t measured the guage yet but if you have yarn that calls for smaller or bigger needles, let me know and I can measure…

CO 24 sts
1. knit first row, joining together to make a round
2. [k4, M1] repeat (rpt) to end of row
3. knit
4. [k5, M1] rpt to end of row
5. knit
6. [k6, M1] rpt to end of row
7. knit
8. [k7, M1] rpt to end of row
9. knit
10. [k8, M1] rpt to end of row
11. knit
12. [k9, M1] rpt to end of row
13. knit
14. [k10, M1] rpt to end of row (should have 66 sts by now)
15 – 25. knit 11 rows
26. [k9, k2tog] rpt to end of row
27. knit
28. [k8, k2tog] rpt to end of row
29. knit
30. [k7, k2tog] rpt to end of row

start nipple colour here

31. knit
32. [k6, k2tog] rpt to end of row
33. knit
34. [k5, k2tog] rpt to end of row
35. knit
36. [k4, k2tog] rpt to end of row
37. knit
38. [k3, k2tog] rpt to end of row
39. knit
40. [k2, k2tog[ rpt to end of row
41. knit
42. [k1, k2tog] rpt to end of row (should have 12 sts now)
43. knit
44. k2tog for whole row (6 sts remaining)
45. knit (knit another row if you want nipple “taller”)
cut yarn, thread tail through remaining 6 sts, tighten and knot
pull tail into breast with crochet hook, leaving it inside

Stuff the breast with stuffing, insert disc, and se

A web site that has most of the Lower-Mainland kids swap meets listed can be found at the following website address
http://www.kidsvancouver.com/events/swapmeets

MAKE A KNIT VAGINA FOR DEMONSTRATING PARENIAL MASSAGE
1) Cut the top off bottle to create the inside of the vagina and the shape for the cervix. Keep the bottom of the bottle for later. Fro the top of the bottle to the incision should measure 5.5 inches.
2) Put tape on edges to soften them so they don’t cut through the yarn later.
3) Knit the needed pieces ABCD
A) Knit the outside:
This piece is the large cover for the outside of the puppet. It will cover the bottle. Knit it out of skin tone yarn
Cast on 52 stitches
Knit 62 rows or 15 inches x 7 inches
Cast off
Once done knitting the rectangular shaped piece darn it down the long side of the rectangle to create a 7 inch ling tube that will be put on your pop bottle/vagina later.

B) Knit the vulva: use the same color yarn as you did on the piece A.
Cast on 21 stitches
Knit 4 rows with 21 stitches
5th row reduce by one stitch-every second row continue to reduce 1 stitch till 10 stitches remain on your needle. Then cast the last 10 stitches off.
Do the same lip pattern again to create the second lip.

C) Knit the vagina: Use a Darker tone for this part, I
choose a rich pink hue but there is much variety in vaginal color so you can personalize it.
Cast on 20 stitches
Knit 4 rows of 20 stitches
Begin to remove 2 stitches from each row following till you are left with 8 stitches on your needle.
Knit for 3 inches (the average vaginal canal) or around 27.
cast off and then do pattern C again.

D) Knit cervix patch.
Cast on 8 stitches
Knit 20 rows
Cast off

NOW THAT YOU KNITTING IS COMPLETE LETS PUT YOUR VAGINA TOGETHER.

1) Darn together the vulva at the ends. The ends being the rounded larger sides. Darn a little over an inch on the bottom and a ½ inch on the top. Leaving what will become the vaginal opening.
2) Make the shape for the vaginal lips:
Get some stuffing (not to much) and roll it between your hands to give it the correct shape.
Put it on the edge of the curved side of the vaginal lip, making sure it is a bit higher set, leaving room that will become the perineum body.
Roll the knit over the stuffing and then darn the edge of the rolled knit to the side of the knit (this is difficult to explain , so I would watch the demonstration video supplied).
DO it again to the other lip.

6) Darn together the internal vagina. Darn the one long side of the vagina take the knit cervix from pattern D and darn it onto the combined vaginal pieces on the bottom, or smallest end.Darn the other long side of the vaginal to create a tube like shape.

If you want to vote for Kathie, you can do so at the Our Bodies Our Selves website.

http://www.ourbodiesourblog.org/blog/2010/04/the-guiding-force-in-perinatal-education-in-canada-kathie-lindstrom