Bringing birthing home:

🕔Sep 22, 2008

Celina Laursen, now a midwife-in-training, was pregnant with her first child when the front page of her local newspaper screamed in big black type, “Don’t give birth here.”
It was 2000 and she lived in the tiny community of Tlell on the east beach of Haida Gwaii. The islands’ two hospitals, in Masset and Queen Charlotte, were facing staff crunches. Expectant moms were told that the doctors there could not guarantee safe maternity care.
Laursen, and many of her friends who were also pregnant at the time, had no resources or desire to go off-island. “So we just stayed,” she says.
She had her baby (ironically she was medevaced to Prince Rupert when her water broke—a decision made by a doctor she has not seen before or since on the islands) and everything went fine, but the whole process left her feeling that something was very wrong.
“It seemed so strange to be told not to have our babies in the place where we live,” she says.
And so began Laursen’s nine-year journey to become the change she wanted to see in her world. By the spring of 2009, she will be one of a growing number of university-trained registered midwives in British Columbia. Once she graduates and delivers 20 more babies (in order to become certified in a remote area), she intends to set up her practice at home, in Tlell, where she belongs.
Recent recognition
Midwifery was not recognized within British Columbia’s health care system until 1997, even though women, First Nations or otherwise, had been attending births and providing pre-natal care for their neighbours since human time began.
In modern medical history, these women were called “lay” midwives and generally weren’t allowed to practice within hospitals, although many would accompany expectant mothers as labour coaches. Although they had often gone to great lengths to educate themselves and get training elsewhere, their credentials were not recognized by the medical profession here—and, in some cases, still aren’t.
Laursen met one of these lay midwives on Haida Gwaii and says her support and encouragement led to her application to the new four-year midwifery degree program at UBC, which started in 2002.
When she learned she had the option to do part of her studies internationally, Laursen was able to realize another dream, of travelling to Africa—and all the time she was thinking back to her future practice on Haida Gwaii. Her clinical training had been comprehensive, she says, but while working in BC Women’s and Children’s Hospital any complications were immediately looked after by obstetricians, pediatricians or other specialists who were always on hand.
“It’s great, but we don’t have that on Haida Gwaii,” she says, where even the need for a caesarian section means sending the patient to a bigger centre. “Because it’s so isolated here the resources are not the same as other hospitals in British Columbia.”
In Africa, not only could she get a different perspective by working with midwives from a different culture, she’d get experience that would be difficult or impossible to get in Canada.
Off to Africa
And so she did. At the Mulago Hospital in downtown Kampala, the capital city of Uganda with a population of more than 1.2 million, she became immersed in the sounds of labour—the screaming, moaning and pushing—of a very busy maternity ward.
The delivery rooms had cement floors, and women laboured within a couple of feet of each other on cots separated only by dirty, pink curtains. As she walked through the room, mothers-to-be would clutch at her arm, pleading “Musawo, musawo”—a term that is used for any health care practitioner.
So right at the start she learned one of her first important lessons. With all the clamour of women in pain, she wanted to reach out to everyone, but was amazed at how short a time it took her to get used to the calls for help. “You have to go and do the things you need to do, and then help one person at a time,” she says.
During a typical day at Mulago, she might assist with, or “catch,” three or four babies, (although one day Laursen was involved in eight births). On these busy days, she remembers bumping backsides with other midwifes as she bent over the task of guiding the new lives out of their mothers’ birth canals.
So much was different about the child-birthing experience in Uganda, but the supplies each woman would bring to the hospital was a detail that stuck with her. Pregnant women arrived carrying a colourful plastic basin packed with things they need, including a roll of cotton, a couple of syringes, three or four sets of sterile gloves, a razor blade (for cutting the cord), cloth for the baby and a kavera—the plastic sheet that would cover the bed they’d give birth on.
“Everyone knows from their sisters or aunties what to bring, but if they didn’t have money for this, we would use what we had at the hospital.”
Keeping the kavera in place during labour is essential, as it helps contain the fluids, something extremely important in a country that has been impacted by HIV and AIDS. The midwives rely on the birthing mom to do this. Sometimes, Laursen says, the midwives swatted women to remind them to keep their kavera in place. This was another important lesson she learned: midwives in Uganda don’t have the same gentle, nurturing reputation they have in Canada.
Cultural contrasts
“Here we go the extra mile, building relationships and supporting women. But in Uganda midwives are known to be a bit harsh.”
Laursen encountered different standards of cleanliness, and watched as women birthed their babies and then were “up and out,” walking themselves down the hall to the post-partum ward. “It’s shocking,” she admits, but she didn’t want to judge these different practices, just learn from them.
“I was really happy to be there and make it into an exchange,” she says. “An exchange of skills and stories with other midwives and birth attendants.”
And she learned things that will be essential to her own practice. After several weeks in Kampala she spent another week and a half in a smaller village hospital in Masaka, where there was no division of high- and low-risk pregnancies.
“Anything could come in the door—any emergency or stage of pregnancy.” She witnessed miscarriages, incomplete abortions, prolapsed cords (the cord coming out before the head), stillbirths, and helped women with malaria and post-partum hemorrhages. It was in this village that she was able to practice something that no midwife ever wants to have to do, but must be experienced in: baby resuscitation.
Both Laursen and the profession of midwifery have come a long way in the last 10 years. Legislation has brought the practice into the mainstream, with universal health-care funding for services now provided in most provinces, including BC. Midwives have hospital privileges, the right to prescribe medications needed during pregnancy, the right to order pre-natal tests, and full consultation access to physicians (she says local doctors have been very supportive of her).
Laursen says the profession has moved so far into the mainstream that some now call it “medwifery,” as opposed to the folkier practice, which could become “midwitchery.”
When she opens for business in Tlell, she plans to offer home births as well as hospital births in her practice, but worries that midwives still have to deal with a lot of misconceptions about what they do. But today’s trained midwives aren’t just for hippie-types, nor do they only offer drug-free births. Her goal is to offer women on Haida Gwaii the services they want. This includes home or office visits and prenatal and post-partum care. In the future, she hopes that the regulations will open up and she can offer a host of women’s wellness services to those who aren’t about to be moms as well.
Most importantly, she wants women to feel that they have a choice about giving birth where they feel most comfortable.

Adding up the stats on midwives in BC
• 40 women on Haida Gwaii are pregnant each year, on average, but there were just eight births on Haida Gwaii in the one-year period April 2007-March 2008.
• There are 132 registered, practicing midwives in BC, but only five in the Northern Health Region (and all of those in Prince George).
• There were 2,125 midwife-assisted births in BC in 2005, of which 423 were delivered at home.
• There were 40,263 births in BC in 2005.
• 10 students per year are accepted at the UBC midwifery program.
• To become a midwife, a woman must attend 60 births; five of these must be in a home and five in a hospital.
For more information:
Midwives Association of BC:
UBC Midwifery Program:
College of Midwives of BC: