For nearly half a decade it's been illegal for midwives to perform home births, but they're still being done. A special report from the home-front lines of baby delivery.
"I remember having nightmares," says Marie, a midwife who has risked her career by practicing home births. For most of the 1990s she helped women give birth at home, without any problems. But then the province passed its midwifery act in 1999, and suddenly what she was doing became illegal. So Marie took her home-birth business underground. And that’s when she started having nightmares about getting caught.
Quebec’s 1999 law pulled midwives out of the grey zone and gave them professional status. But it also took away their right to perform home births. Right now, midwives can’t deliver babies outside of birthing centres unless it’s an emergency. That may soon change. But midwives such as Marie haven’t waited for permission from the government to do what midwives have been doing all around the world for centuries.
Just after the law took effect, Marie got a call from the then-president of Quebec’s newly minted Order of Midwives. The order was putting out the message that it wouldn’t tolerate anyone who didn’t play by the rules. "And they say, listen, if we hear about you [performing home births] again, we’re going to sue you." Marie’s response? "You do your job, I’ll do mine." All told, over 10 years, she figures she’s taken about 400 home-birth clients.
Currently, there are about 85 licensed midwives in Quebec. There’s no way of knowing how many are defying the law by assisting home births. Estimates from midwives themselves range from a handful to as much as 50 per cent. But it’s next to impossible to get an accurate number, because the midwives are tight-lipped about who’s doing it, even among themselves.
Catherine Chouinard was able to have her last baby at home, thanks to her contacts. She worked in a birthing centre and knew who would help her out. But she says it was all very cloak-and-dagger. "It was very secret, I couldn’t say who it was, not even to my family or friends. I couldn’t slip up."
Two midwives came to Chouinard’s home late one snowy night in 2000 to deliver her baby. Afterward, when it was time to fill out the official forms, the father wrote that he delivered the baby. As far as the government is concerned, the midwife showed up after the fact, to check that everything was fine with mother and child.
Another midwife, who isn’t willing to be named, described another clandestine way of delivering babies at home. She screens her clients, making sure that the mother has already given birth several times, and that they were uncomplicated, fast births. The midwife tells the mother to call her once she’s well into labour, so that by the time the midwife gets there with her equipment, the baby is too close to being born to risk transferring the mother to a birthing centre. Then the midwife is able to record that it was an emergency delivery, a "precipitous birth," which is allowed under the law.
No place like home
Sinclair Harris works as a midwife at a Montreal birthing centre that’s located on the top floor of a CLSC. She says they try to make the rooms as much like home as possible, but they still come off feeling like a motel. "It’s still for many women an institution… and also they’ve got to move from their home to come here, and they’ve got to move from here back to their home to nest with their babies. Which some people feel is a very difficult transition, and they would much prefer that it all take place in the same place."
Allison Steward is 38, British, and very pregnant with her sixth child. Three of them have been born at her home in England, but this is her first in Quebec. Steward says she was "horrified" to find out midwives weren’t yet allowed to attend home births in Quebec. In England, about 1 per cent of women choose to give birth at home. Steward says being at home means she doesn’t get impatient. "You can potter around the house… you don’t have to worry about when I should go to hospital, you can just get on with your life and ignore it. And it’s relaxing because it’s keeping your mind off it."
Steward has written letters and lobbied the government to get on with it, but she’s running out of time. "And I was expecting then, by October, that I would be allowed to have my home birth. But it seems that there are further delays, which I find very frustrating."
Doctoring the law
Quebec’s midwifery act was written to permit home births, but not until the Order and the government agreed on the terms. This spring, the midwives submitted their official proposal. Now it’s sitting with Quebec’s Office des professions, the body that regulates the province’s professional orders. This month or next it will review the midwives’ plan for home births and then recommend to Jean Charest’s cabinet whether or not to accept it, modify it, or reject it.
Quebec’s Association of Obstetricians and Gynecologists is one of the biggest opponents to home births. Claude Fortin, president of the association, puts it this way: "Sometimes when I have an emergency at the hospital, I have to react in two or three minutes to save the mom or to save the baby. And this is where we are concerned; even if they have an ambulance in front of the home, well we hope the hospital is not too far."
Fortin acknowledges that home births won’t be forbidden forever in Quebec, and that’s why the ob-gyn lobby is trying to shape the rules that will permit them. It’s made recommendations that would severely restrict who is allowed to give birth at home. If the Office des professions listens to the doctors, then only women who live close to emergency obstetrical services will be allowed home births.
Labouring the truth
The current president of Quebec’s Order of Midwives says the doctors’ concerns are unfounded. Raymonde Gagnon defends home births by pointing to studies that show a woman in labour can encounter just as many risks at hospital as at home. But despite being in favour of home birth, the president insists she’ll crack down on any of her members who perform them before they’re allowed under law. Order members face fines, suspensions and losing their licenses if they’re caught.
But so far the order hasn’t had any complaints about home births, so no order members have been punished. How much does the order know about its members who are breaking the rules? When pressed, Gagnon remains firm. "Right now, there’s no situation to lead us to believe that our members are practicing home births."
Marie hasn’t delivered any babies, at home or in a birthing centre, since she took unpaid leave two years ago to have her third child. And she hopes that when she rejoins the order next year home births will be allowed.
Marie knows some midwives will feel she shouldn’t speak out, especially now that the province is considering permitting home births. She says some midwives think she’s setting back "the cause" by talking openly about the covert practice. But Marie thinks she’s providing a vital service to women who want home births. She admits it’s strange, but she compares herself to Dr. Henry Morgentaler, the famed pro-abortion crusader. "He would keep on doing abortions even if it wasn’t legalized because he really believed in it. And he helped so many women to have it done, it was really important for them. And finally years later, it was legalized." She says it’s unfair to ask a woman to obey a law that is only temporary. "You’re giving birth about two times in your life, and you’re supposed to wait until the regulation has happened. I don’t buy that, it doesn’t go with my philosophy."
To listen to the radio version of Jessica Brando’s report go to www.cbc.ca/montrealmatters. Also, look for a piece that deals with issues around this story on CBC TV’s Canada Now news program this evening after 6:30 p.m.