Deja Vu in Delivery: Why Cape Breton's Maternity Care is Trapped in a 90s Time Warp
- Melissa Cowl
- 3 days ago
- 3 min read
Updated: 2 days ago
Part 2 of 3
With over three decades dedicated to supporting new families as a doula, doula trainer, and childbirth educator in Ontario, I've witnessed a remarkable evolution in maternal care. From the early struggles to integrate midwifery into the mainstream, to the thriving, collaborative models we see today, the journey has been long and often challenging. Yet, working in Cape Breton in 2025, a disheartening sense of déjà vu has settled over me. I find myself transported back to the mid-1990s in Ontario, a period of significant friction and resistance in maternal care that I had hoped was firmly in the past. This regression is not just sad; it's a profound disservice to the families of Cape Breton.
In 1994, when midwifery was finally regulated in Ontario, and thus in my small, rural Ontario community, it was met with a fierce resistance. There was a clear demand for services from pregnant individuals, but the established medical community offered almost non-existent support for these new professionals. With only one working obstetrician in town, the unspoken question hung heavy in the air: would two midwives "cut into his piece of the pie"? Were there enough people to sustain three primary care providers for birthing families?
The answer, as it turns out, was a resounding yes – and then some. But getting there was an uphill battle. Outlying, bigger, regional hospitals deliberately dragged their processes to grant privileges to registered midwives. In hospital settings, both nurses and doctors continually undermined midwives, often in misguided attempts to squash their clinical care practice and reveal, mistakenly, that their care was substandard. There seemed to be a palpable competition for numbers, a fear that welcoming midwives meant less work for others.
Unsurprisingly, as midwives began to offer their unique model of care – continuity from pregnancy through to six weeks postpartum, encompassing both the birthing person and the newborn – more people chose to remain in our small town to have their babies. This shift created more work, not less. While family doctors understandably began to opt out of providing care through labour and birth due to the demanding, unpredictable on-call work, the overall system expanded. Support staff like doulas, lactation consultants, and lab technicians all became busier. Soon, more midwives were brought in, and more obstetricians followed suit.
Today, that same small Ontario town, which once struggled with just two midwives and one obstetrician, now boasts eight working midwives and six obstetricians. The collaborative environment has led to innovative programs that directly address community needs. Our midwives have launched initiatives like:
Newborn Exams & Early Discharge Support: Midwives assess newborns and assist in early hospital discharge, helping families settle in at home sooner.
Postpartum Wellness Checks: Comprehensive checkups for both parents and babies, including crucial breastfeeding support and guidance.
Jaundice Care & Home Phototherapy: Providing bilirubin follow-ups, with home phototherapy soon to be available for babies with jaundice.
Virtual Prenatal Breastfeeding Classes: Expert-led online sessions covering essential topics and FAQs to prepare parents.
Virtual After-Baby Support Groups: Midwife-facilitated groups offering connection and shared experiences in a supportive environment.
Behavioral Activation Talk Therapy: A vital service open to all new parents for emotional well-being support.
Hospital Staffing Support: Midwives even assist hospital nursing and OR staff as needed, demonstrating true integration.
This level of robust, integrated, and comprehensive care is what Ontario has built over three decades. Midwives there can manage IUDs, are chiefs of departments, and have created sustainable models in rural and remote communities with a strong sense of autonomy.
Yet, here in Cape Breton in 2025, I see the struggles of 1994 playing out again. Why is the Cape Breton Regional Hospital not immediately granting privileges to the one midwife who has applied? With the recent retirement of an obstetrician and the undeniable busyness of the island's only birthing unit, the extra hands and the invaluable model of care a midwife offers would be immensely helpful. Instead, we see the echoes of those early days: the medical community trying to limit what midwives are allowed to do and how they can manage care.
It is baffling and frustrating. Thirty-one years later, a province not that far from Nova Scotia has forged ahead, embracing a collaborative model that benefits everyone – most importantly, birthing families. The parallels between Cape Breton's current predicament and Ontario's past are not just striking; they are deeply concerning. It's time for Cape Breton to learn from history, not repeat it. The health and well-being of new families across the island depend on welcoming, integrating, and empowering midwives to provide the care they are trained for, and that communities so desperately need.
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