legalised in British Columbia
During the morning of Sunday May 9th I was wandering round the conference area at the Vancouver Trade Centre. I was stopped by a man who asked me what was going on and what were these posters about midwives. Before I could answer he told me very proudly that he and his wife had midwife care for the births of three babies. When I explained the nature of the Congress of the International Confederation of Midwives he was delighted and wished us all well before he rushed off. I hope he was as ecstatic as all the congress participants were with the news given by Elizabeth Cull, Minister of Health for British Columbia (BC) that legislation is to be drawn up to legalise the practice of midwifery. It was an uplifting experience to be present and participate in the delight and pleasure as the news was announced, and to relive it again in the television broadcasts later that day. The decision that midwifery is to be legalised in a third province in Canada is a testimony to the hard work of midwives, women and men in BC in their fight to bring to the attention of the relevant authorities that women should have a right to choose the style of care they want when having a baby. However, the midwives in Vancouver have been warned that their battle to ensure that the style of midwifery they want to provide, and that women want, becomes a reality is about to begin. This may be a strange statement to make immediately after they had been given such wonderful news, but there were two riders in Elizabeth Cull’s announcement which show how right the speakers were who made that statement. The first rider is that all pregnant women have to be examined by a doctor (presumably to assess the women’s suitability for that style of care), and the second is that home confinement will only be allowed for those women considered to be at low obstetric risk.
Why do all pregnant women in BC need to be examined by a doctor? Is the health service in Canada so poor that women who need to be cared for by obstetricians will not already know of this particular risk so that all women have to be screened at this time? It is not difficult to envisage that some of the obstetricians are likely to persuade women that they would be better having obstetric care ‘just in case’. How many women are going to be able to resist the moral blackmail of ‘if you only have midwifery care you are going to put your baby’s life at risk’. There is evidence from both Holland and the UK that once a woman is referred to an obstetrician by a midwife the woman is retained within the obstetrician’s sphere even if the reason for referral has been resolved. There is the potential for the doctor to ensure that the woman never even gets as far as the midwife. In the television reports about the decision that home birth can be an option in BC some obstetricians stated that this was not safe and that the woman would be putting both her own life and that of her baby at risk. They gave no evidence to support this statement, and again how easy is it going to be for a woman to resist this moral blackmail? In her welcome to the congress the President of the BC College of Obstetricians said that the obstetricians were pleased that midwifery is to be legalised and would welcome midwives as members of- their organisation. Whilst this sounds promising I sincerely hope the obstetricians are not going to use this in an attempt to control the practice of midwifery. The control that some BC obstetricians seem to want to retain is in stark contrast to the style of care that too many women throughout the world have to endure whether they are at high or low obstetric risk. During the congress speakers from the developing world told us that too many women do not even have access to a trained 103
traditional birth attendant, let alone a midwife. In theirjoy at the news that midwifery in BC is to be legalised the BC midwives acknowledged the help of many midwifery organisations throughout the world. They can be assured that this
support will continue in the work which has to be done to develop the legislation which is sensible and protects both the public and the midwives. ANN THOMSON