Call to Action: A Tale of Exceptional Care and a Family Plea for Midwifery Collaboration

Part 3 of 3

Read Part 1

Read Part 2

With decades of experience teaching doula courses across Canada, the USA, and Europe, and having attended countless births in diverse settings, I've witnessed the full spectrum of maternity care providers – from the truly exceptional to the seriously lacking. I've had the immense privilege of collaborating with outstanding doctors, midwives, and nurses, and unfortunately, I've also encountered those whose care fell far short.

Recently, I had the honour of attending a birth at Cape Breton Regional Hospital (CBRH). This particular client's prenatal care, managed by midwife Mianh Lamson, a Nova Scotia Registered Midwife, had been a challenging journey. Routine lab work, sonography, and OB consults felt disjointed and, at times, dismissive because of a lack of professional collaboration. Thankfully, the midwife tirelessly pieced together the fragments of her care, advocating for her client time and time again. It often felt as if the system was unwelcoming to midwifery clients, creating unnecessary hurdles.

The mother-to-be made four separate and arduous trips to emergency and urgent care with a significant medical problem in her second trimester. Each time, her concerns were deprioritized, attributed to anxiety, or simply not addressed after waits exceeding 12 hours. Pregnant, exhausted, and hungry, she returned home four times without a diagnosis or relief. It was only through the diligent collaboration of her midwife and family doctor, a shared-care model made possible by her specific location, that her medical issue was finally addressed, and all turned out well. In addition, a series of tests should have been done by the consulting obstetrician and only half of the series was done. The documentation indicated that the patient declined further testing but this was not the case at all.

My apprehension about attending a birth at CBRH was palpable, not least because of these prior experiences and a 2021 CBC article highlighting the hospital's unusually high caesarean rate for low-risk, healthy mothers. My deeper concern stemmed from the seemingly systemic issues my client had faced.

What unfolded within the labour and delivery unit, however, completely blew me away. In thirty years of attending births, I have never, ever witnessed a nurse like the primary nurse assigned to this birthing person. Words cannot adequately describe the calibre of care provided to this mother and her partner. The nurses who came in for breaks were wonderful, and the nurse who came on at shift change was equally awesome. Most remarkably, the first nurse stayed two hours (or perhaps more) past the end of her shift, offering steadfast assistance, bearing witness, and providing invaluable continuity of care. Their dedication was truly above and beyond. The family doctor was ever-present, encouraging, delightful, and informative. When she consulted the on-call OB, options and choices were provided with clear information, pros and cons, and alternatives – a true model of informed consent.

So, where was the midwife in this otherwise exemplary hospital team?

In a collaborative profession like maternity care, whether in Ontario hospitals where I’ve worked or across healthcare systems worldwide, inter-professional collaboration is essential. In this case, the midwife – the person who knew this woman best, who had supported her through weeks of frustrating prenatal care, and who had established a deep, trusting relationship – was not present at the hospital birth. Yes, an excellent care team was there. However, from the perspective of the birthing person and her partner, the crucial continuity of care had been fundamentally shifted. Easy, simple requests to make the birth personal, positive and memorable were not fulfilled. It made an impact.

This midwife, despite being educated, experienced, and fully qualified, has no hospital privileges at CBRH. Her comprehensive prenatal and postpartum care is not formally recognized by any support staff within the hospital system. She remains an outsider. She will not receive the labour and birth reports from the hospital. While she will continue to provide essential postpartum care for both the parent and child, vital information, resources, and continuity are generally not made available to her.

Midwives are actively working and thriving in urban centres across Nova Scotia. In Halifax, there is a concentrated effort underway to reduce the caesarean rates. This team collaboration includes midwifery, Yet, for rural and remote communities in Cape Breton, where midwifery could provide the most beneficial outcomes – alleviating burdens on emergency rooms, offering holistic prenatal support, and reducing the need for high-intervention births – the hospital appears to be dragging its heels in allowing them full, integrated access.

Due to the vast expanse of Cape Breton, coupled with weather challenges, unplanned, unassisted home births, car births, and other potentially unsafe situations have been problematic in the past. The six weeks following childbirth are a critical period, and the consistent care provided by a midwife during this time offers invaluable support for new parents and their babies. This dedicated care ensures that all questions, from infant sleep to parental recovery, are thoroughly answered, empowering families with knowledge. Midwives meticulously monitor the health and wellbeing of both parent and baby, quickly identifying and addressing any concerns, including promptly resolving common feeding issues, whether breastfeeding or bottle-feeding. Beyond immediate care, they act as vital connectors, providing access to essential resources and making necessary referrals to specialists, ensuring comprehensive support. Crucially, this period of care is also filled with much-needed reassurance and positive reinforcement, helping parents navigate the demanding early weeks with confidence and a sense of being well-supported. Much of this can be alleviated with the addition and formal recognition of midwives, and crucially, the willingness to provide a truly integrated care model.

While individual instances of exceptional care, like those I witnessed at CBRH, are vital and deserve immense praise, they cannot fully compensate for systemic gaps. True excellence in maternity care requires seamless collaboration, mutual recognition, and the full integration of all qualified professionals. For the families of Cape Breton, advocating for this essential change is not just about convenience; it's about optimizing safety, continuity, and the most positive birth outcomes possible.

We need you to spread the word!

1. Call the hospital CEO.

2. Send letters to the Board.

3. Make local news sources aware of the situation.

4. Contact us.

#thedoulagroup #CapeBreton