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When Mianh Lamson moved to Cape Breton, Nova Scotia, a few years ago, she didn’t plan on becoming a midwife. But people she met in her community of Inverness kept telling her to do it.
“We heard a strong voice saying there was more interest in access to health care for women, care for newborns and the postpartum period, and the kind of care that midwives can provide,” she said in an interview.
Lamson is a registered midwife with 15 years of experience, but there were no midwifery jobs on the island when she arrived. Nova Scotia’s current model has midwives working exclusively out of three locations: Halifax, Antigonish and the South Shore.
Her plan was to continue her practice by traveling to other parts of the country to do occasional locum tenens, that is, temporary placements to fill vacancies and leave.
“Somewhere along the line I realized it was kind of absurd to drive to Ontario or Quebec to get obstetric care when my neighbor didn’t have access to that and might want it,” she said.
Prenatal and postnatal care from this fall
When Lamson realized this, she contacted a family doctor in her area, and a unique collaboration was born that will begin this fall.
Lamson and another midwife will be working from an existing GP practice attached to the local hospital in Inverness, providing medical care to women and babies during pregnancy and up to six weeks after birth.
The midwives will refer patients to doctors, but people from the community can also refer themselves.
The Inverness midwives will not be supporting births — in hospital or at home — as midwives in other locations do. Lamson said this is largely because the nearest hospitals equipped to provide birth services are in Sydney and Antigonish, both more than 100 kilometres from Inverness.
“There are many people in our community, myself included, who would like to see birth returned to the community. And we are working on that as a long-term goal,” Lamson said.
Reducing the pressure on doctors
Lamson contacted Dr. Susie Egar.
“I’m very glad she did,” Egar said in an interview.
“In most communities, and certainly ours, improved access to primary care is needed.”
Egar said there are five GPs in Inverness who have a triple task: working in the primary care clinic, keeping the emergency department open and caring for hospital patients.
“That sometimes limits our accessibility to our primary care patients. And so it will be very helpful to have other people who can also work together and also work independently and serve our population in that way,” Egar said.
She couldn’t provide figures on how much additional patient capacity the midwives will add to the clinic, at least not yet, but she did say it will be significant.
Certified midwife Mianh Lamson lives in Inverness, Cape Breton, where there are currently no midwifery jobs, but she’s about to change that. Through a partnership with local family doctors, Lamson is preparing to launch a new midwifery service in the small community this fall.
What made it possible
The maternity service in Inverness is made possible by two programmes that have been established over the past two years.
In 2022, the Midwifery Regulatory Council of Nova Scotia created a pathway for midwives to work outside of the three existing locations, based on patient and community needs.
Under this new offer, registered midwives can submit so-called alternative practice arrangements to the council for approval. The catch is that the council does not arrange funding — midwives must arrange that themselves.
That’s where collaboration with family doctors becomes essential to the Inverness program. Through a pilot program launched last year by Doctors Nova Scotia, midwives can bill doctors, and doctors bill the province.
The billing program is available to GPs who want to add a paramedical professional to their practice to improve access to primary care. It is a pilot program, linked to the last doctor’s agreementwhich expires on 31 March 2027, meaning the maternity service in Inverness will only receive funding until that date.
“We hope that long before then we have good evidence that this has improved community care and access to care and hopefully improved the working conditions of the caregivers in our rural community so that we can have access to more permanent funding,” Lamson said.
The push for more funding
This will be the first alternative practice arrangement for midwifery care in Nova Scotia. Jenny Wright, the regulator and executive director of the Midwifery Regulatory Council of Nova Scotia, said she is pleased to see it happening in Cape Breton, a region that has been underserved for “a very long time.”
“The midwives see a lot of women,” Wright said in an interview.
“They can provide prenatal care, postnatal care, helping mothers with their babies, breastfeeding, contraception, reproductive health. The sheer size and scope of what a midwife can provide is quite powerful and will fill a huge gap in this area,” she continued.
Wright said other midwives have expressed interest in setting up alternative practices, but funding is a major hurdle.
Midwives and advocates have been urging the provincial government for years to invest more money in obstetrics, to address long waiting lists for existing services and to expand services to other regions of the province.
The Ministry of Health and Wellness told CBC News it budgeted for two additional midwives last year, and those positions were filled in Halifax in January.
Still, according to Kalyn Moore, there is still room for more growth.
“The possibilities are endless, if we can just get enough funding.”
Moore is a certified midwife in South Shore and interim president of the Association of Nova Scotia Midwives.
She said the demand for midwifery care in Nova Scotia far outweighs the supply, citing the long waiting list in Halifax and requests for care from people who do not live near existing midwifery teams.
At the start of the year, there were 195 people on the waiting list for midwives at the IWK Health Centre in Halifax. A spokesperson said there were another 36 people on the list who were ineligible for care because they lived outside the service area.
Nova Scotia Health said there is currently no waiting list in South Shore, and in Antigonish there are typically one or two people on the waiting list per month.
“We also receive a significant number of requests for service from people in the province who live in areas where there are no obstetric services. These people are generally not on our waiting lists because they are outside our service area,” a spokesperson for the health authority said via email.
Funding is not the only limiting factor, however. Nova Scotia has sometimes struggled to fill midwifery vacancies. Some midwifery services have been previously suspended due to vacancies.
Change on the horizon
Moore believes that recruiting and retaining midwives would be better if they were able to do their work as fully as possible.
The current legislation governing midwives in Nova Scotia allows midwives to “care for a mother and her baby during pregnancy, childbirth and the postpartum period.” The postpartum period, according to Nova Scotia rules, is six weeks.
Moore said midwives are trained to do much more than that. They can provide reproductive and sexual health care throughout life, not just during and after pregnancy, and they can treat babies until their first birthday, rather than six weeks.
Moore and other midwives are eagerly awaiting a change in management that will allow them to do everything they are trained to do.
With the approval of a law last year new law for the regulation of healthcare professionalsThe Supervisory Board for Midwifery is currently working on new regulations that will come into effect in 2026.
Wright said the province has mandated that midwives be able to practice their profession to the fullest.
“In other provinces, midwives work on a broader and more comprehensive scale. … So this wouldn’t be entirely new to Nova Scotia,” Wright said.
“I think this is a win-win situation for everyone.”
Lamson is already imagining what this change would look like for her fledgling practice in Inverness.
“That would really open it up in a very profound way,” she said.
That’s not so hard to imagine, because it’s how she currently does her work as an observer in northern Quebec.
“We have teenagers coming in who aren’t having babies, and maybe that’s a good time to talk to them about that. And we also have 60-year-old women coming in who still need access to sexual and reproductive health care.
“When you have one central point in the community for all of that care, I think it really creates a trusting relationship with the community, that you are the person they can go to for anything that has to do with that. And that’s really great.”
