Alberta allows midwives to practise in hospitals if patients pay
CMAJ 2000;163(1):74
With new provincial regulations in place, Alberta is set to become the third province, after Ontario and British Columbia, to allow midwives to deliver babies in hospitals. Unlike their eastern and western counterparts, however, Alberta's mothers-to-be will still have to pay for midwifery services out of their own pockets.
In December, Alberta passed legislation that allowed nonphysician practitioners such as midwives to admit patients to hospital and use diagnostic services such as x-rays and ultrasound. Since then, 5 of the province's 17 regional health authorities have been busy drawing up plans for incorporating midwives into their hospitals.
Dr. June Bergman, regional clinical department head for the Department of Family Medicine of the Calgary Regional Health Authority, says such implementation has not always been easy. "Because it's a top-down directive and because the cultures of the groups [physicians and midwives] are so different, the ability to forge an alliance of health care providers who can work in collaboration has been made more difficult," she said.
Despite any logistical difficulties the regional health boards have experienced, there should be little concern over the ability of the midwives to deliver safe medical care, says Sylvia Gillespie, chair of the committee responsible for implementing midwifery regulations in the province and a board member with the Red Deer based David Thompson Health Region. She said Alberta's midwives must pass a rigorous, standardized examination before becoming eligible for registration. Standards of care for the profession are dictated by the Midwifery Act, which currently falls under the Health Disciplines Act.
Gillespie said midwives provide continuity of care throughout a pregnancy, during labour and delivery, and for 7 weeks following the birth. Calgary midwives typically charge $2500 for these services; physicians can bill $295 for the delivery alone. By law, midwives are permitted to handle only low-risk pregnancies.
Permitting midwives to practise in hospitals had been a contentious issue because obstetricians and other specialists they consulted did not receive a consultation fee; such fees were paid only when a family physician asked for the consultation. Thanks to money set aside by Alberta Health's Innovation Fund, however, these physicians will now receive their full consultation rate.
The addition of midwives to the hospital environment should benefit patients, said Bergman, as long as proper guidelines are in place. "I think as long as they are clear on what their scope of practice is, it shouldn't be a problem. We know that doulas [nonprofessional birthing attendants] ... reduce the rate of intervention by something like 30% or 40%. So there are obviously things we can do to elevate or change the comfort level of the mothers [to alter] outcomes. Will bringing a midwife in do that? We don't know, but there's nothing to say that it will do bad things." — Mike Vlessides, Canmore, Alta.
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