What's Really Involved in Becoming a Midwife (& How it Differs From a Doctor or a Doula)

In our 9–5 series, we profile women at the top of their game. This week, Vancouver-based registered midwife Alixandra Bacon talks to FLARE about what *exactly* midwifery is, what it takes to become a midwife in Canada, and why you might want to consider a midwife for your own pregnancy

Name: Alixandra Bacon

Age: 32

Education: Bachelor of science and bachelor of midwifery from University of British Columbia

Current jobs: Registered midwife and co-owner of South Delta Midwifery in Delta, B.C., association strengthening lead for the Strengthening Midwifery services in South Sudan program for the Canadian Association of Midwives, and clinical instructor in the department of family practice at the University of British Columbia

Length of time at current gig: Five years

Midwife Alix Bacon in a white top and jeans, holding a newborn baby, talks to FLARE about becoming a midwife; inline image 1

(Photo: Courtesy of Canadian Association of Midwives)

What inspired you to become a midwife?

My nana had her four babies at home assisted by midwives in northern Ireland, so she was a big influence. I have also always been interested in and committed to reproductive rights and working with Planned Parenthood. In high school, I started volunteering with them and that turned into paid employment. I spent 10 years there in total, and I was quite inspired by a midwife co-worker I had there.

What was your path from school to your first job as a midwife?

I knew I wanted to be a midwife in high school and that the program was incredibly competitive. The year I finished high school was the very first year that the UBC had an intake, and they have hundreds and hundreds of applications. So, I chose to do my bachelor in science and pursue the critical studies in sexuality program. I became a certified sexual health coordinator and used to spend my time traveling around B.C. teaching sex ed. I was lucky because I got in the first time I applied to the midwifery program. I had several placements in east and north Vancouver and Uganda, which I felt prepared me really well for practicing. From there, I started practicing out in a suburb called Ladner and I bought into that practice so I’m the co-owner of South Delta Midwifery now. We care for 12 to 14 women a month in a group care situation.

Alix Bacon, with short blonde hair and brown-framed glasses, with friends at the Toronto March for More Midwives

Left to right at the Toronto March for More Midwives: Alix Bacon, Alberta midwife Bev O’Brien, South Sudanese male midwife Justine Mangwi Juma Olimpio, and Nova Scotia midwife Kelly Chisholm. (Photo: Courtesy of Canadian Association of Midwives)

Is there significant cost involved in becoming a midwife?

It costs more than a nursing degree and less than a medical degree. You have your basic tuition but the extra cost associated is that you’re on call, so you can’t hold another job evenings and weekends and you’ll need a car. You’re expected to do multiple clinical placements over the course of the program and they’ll be in different places, so you’ll have to move at some point. In B.C., it’s required to do at least one rural placement, so there’s a relocation expense involved.

Are there additional costs associated with using a midwife in Canada?

Generally speaking, no. One of the goals of the Canadian Association of Midwives (CAM)—which I have been a representative on since 2014—has been advocating for regulation of autonomous midwifery that’s publicly funded across Canada and so you will find that there are only two jurisdictions left that aren’t regulated: the Yukon and Prince Edward Island. The only place where it’s not publicly funded is Newfoundland. There are provinces like Alberta where it’s underfunded—where funding for the year is usually used up by September and if you want service from September to December, you’re probably out-of-pocket. But other than Newfoundland and Alberta, a midwife would be covered by your provincial healthcare program.

Alix Bacon in a blue patterned top, beaded necklace and brown-framed eyeglasses.

(Photo: Courtesy of Canadian Association of Midwives)

How would you describe a typical workday?

It varies amazingly. My workdays look one of two ways. One way is that it could be a clinic day, in which case I’m in the office from 10 a.m. to 6 p.m. and my appointments range from 30 minutes to an hour with my clients, so I’ll see probably 12 to 14 clients in a day, and that’ll be an appointment for postpartum checks for moms and their babies.

The other way that my day could look is an on-call day. At my practice we do 24-hour call shifts, so I go on call at 6 p.m. and I carry the pager so clients can reach me 24/7 and that might be with an urgent question that can’t wait or a need for a clinical assessment. I put on the pager at 6 p.m. but it’s almost guaranteed if a woman’s in labour, she’s going to call you sometime between 10 and 11 p.m. (laughs) and I will go to her house and do an early labour assessment there, rather than have her come to the hospital and possibly get sent home if she’s too early. So, that will be taking her blood pressure, listening to the baby’s heartbeat, assessing the baby’s position, measuring her belly, and then a cervical assessment to see how far along she is in her labour process. If she’s in the active part of labour, I stay with her from that point until an hour or two after the baby is born. It would be her choice whether we stay at her home or at the hospital.

In your experience, what proportion of births happen at home vs. in hospital?

In my personal practice, 40 percent of births are at home and 60 percent are in the hospital. That’s a high home birth practice though—the average in B.C. is more like 20% home births.

If someone has a home birth, and there are no complications, is it conceivable that they won’t have to go to the hospital?

Yes, that’s right. If someone is planning a home birth, when they get to the pushing stage, I call a second midwife. Occasionally, if you’re in a rural area or something, you might be calling a paramedic or a labour and delivery nurse who you work with in partnership, but usually it’s another midwife, and they come to the house so we have a second set of trained hands. We have essentially all the same equipment you’d find in a hospital in a home birth bag. If they need an IV, I have an IV. If they have a hemorrhage, I carry four different hemorrhage medications, the same four that are carried at a hospital. If they need oxygen, I have oxygen. If they need a catheter, stitches, everything is in the bag.

Alix Bacon in a pink buttoned shirt, dangly earrings and brown-framed glasses in front of a poster for the Canadian Association of Midwives.

(Photo: Courtesy of Canadian Association of Midwives)

Can you explain in your own words the differences between a midwife and a doctor?

A midwife is an expert in low-risk pregnancy and birth. So, the midwife has gone through a recognized university education program that’s usually a branch of the school of medicine. But instead of focusing broadly on medicine like a general practitioner would, your entire time is focused on low-risk pregnancy and birth. Like a physician, we have admitting privileges to hospital, we can prescribe medication, we can order diagnostic tests like blood work and ultrasounds. So, those parts of the experience look very similar in terms of a midwife and a family physician. Both of them would be covered by your provincial healthcare and both would look after the mom and the baby afterwards. So you’re really looking at differences in terms of length of appointment times. Midwives have longer appointments and we usually have a few extra appointments throughout the pregnancy. We also offer choice of birth places and home visits in the first week after the baby’s born.

And I would say there are some differences in philosophy of care. There’s a bigger gap between a midwife and an obstetrician. The obstetrician is an expert in high-risk pregnancies and they have skills that midwives do not have, so we will often work in partnership with them, for example if a complication comes up in a pregnancy. But their care looks quite different in that they have shorter appointments because they’re seeing a much higher volume of clients in the model of care they work in. The other difference you’ll find is that family physicians work in a larger call group. So, a midwife will work in a smaller call group which means that the midwife will meet every mother prenatally and it means a mom will not have a stranger at their birth. Physicians work in larger call groups so the person you see throughout your pregnancy is likely not to be the person on-call on the day that you have your baby. And then an obstetrician doesn’t take care of babies. After birth, the mom would get postpartum care from the obstetrician, or perhaps a nurse practitioner, and the baby would have to see a family doctor or nurse practitioner.

What are the differences between a midwife and a doula?

A doula is a labour coach. They have no medical training or responsibility. They’ve often taken a weekend course on how to coach someone in the labour process. They’re somebody who would be present only for the labour and they might support a woman whether she’s at home or hospital, whether she’s with a midwife or physician. A midwife is an autonomous healthcare provider. They are qualified to provide all the prenatal and postpartum care for a health, low-risk person.

It’s been reported that there is a shortage of midwives in a lot of areas of Canada. What are your thoughts on that?

The challenges are multi-faceted and depend on where we are in Canada. The vision of CAM is that everyone in Canada will have access to a midwife’s care for themselves and their baby and we’re working on that both on the national level and in each provincial and territorial association. In some places, the delay is simply the ability to grow more midwives through school. We have midwives who also take a bridging program, so they’ll be internationally trained and take a shorter program to fill in whatever gaps they have between where they’ve come from and Canadian standards of care. In places like P.E.I. and the Yukon, there’s no regulation and in other places, the delay is lack of funding. Newfoundland has no funding at all. As mentioned earlier, funding runs out in Alberta before the end of the calendar year so there are women without access. You also see different models of care in terms of whether someone is a hospital employee, like in Saskatchewan where it’s up to the hospital to determine how many midwives they’re funding. That’s the case in New Brunswick as well where they only fund two positions, and in Nova Scotia there are only nine positions. So, that is a limiting factor in some places. In other places where the midwives are financially autonomous and are paid through their health insurer, it’s about getting support for integration and support to work rurally because you can imagine if you’re the only midwife in a rural community, it can be very isolating and challenging to be on call 24/7 for a year.

Alix at South Sudan reception during ICM 2017 in Toronto: Alix Bacon, Esperance Fundira (UNFPA South Sudan Country Representative), Dr. Natalia Kanem (Acting Executive Director UNFPA). (Photo: Courtesy of Canadian Association of Midwives)

Alix Bacon (left) at South Sudan reception during the 2017 International Confederation of Midwives with Esperance Fundira (UNFPA South Sudan country representative) and Dr. Natalia Kanem (acting Executive Director UNFPA). (Photo: Courtesy of Canadian Association of Midwives)

Is a big chunk of your time dedicated to working on some of these federal regulation challenges?

Absolutely. CAM invests quite heavily in advocacy in those jurisdictions. We have also been working federally to achieve what they call “federal occupational application” and that’s required if a midwife is going to work on salary in a federal jurisdiction. So, to give you an example, a federal prison. They can’t provide care because midwives are not recognized on the government’s list of official occupations. We’re also working for student loan forgiveness, which nurses and physicians have, but midwives don’t have access to currently. We’re also working really hard to bring birth closer to home for all Canadians, but particularly in Indigenous communities. So, we support the National Aboriginal Council of Midwives and work with them for advocacy. A recent win for us was in June, the federal health minister announced that the government will allocate $6 million in funding over five years to projects in First Nations and Inuit communities.

What is the most challenging part of the job?

The most challenging part of the job is probably the on-call lifestyle.

How do you work towards achieving work-life balance?

It’s a key piece that you need to learn in your midwifery education outside of clinical skills. It’s important to have good boundaries, so when you have your off-call times, you take it. It’s important to have that unplugged time. And then taking care of yourself is key. When you’re any kind of care provider, it’s easy to forget to take care of yourself. You’re busy thinking about making sure everyone else has eaten and everyone else has slept. Good hygiene, good nutrition, getting to the gym three times a week and yoga three times a week is crucial for me.

How do you like to unwind?

I’m a gardener, so I like my garden. I grow my veggies. I really enjoy cooking, so on my best day off, if I can’t be kayaking, I will spend an entire day making a multi-course vegetarian meal for a friend.

What is the best part about your job?

My absolute favourite part of the job is when babies I delivered a couple years ago come back when their moms are pregnant again and help me with the belly check. We listen to the heartbeat together and take their mom’s blood pressure and let them know we did all those things with them. It gets me every time.

It sounds like the birth experience can be much more personal with a midwife than the alternative.

I would agree. We’re so privileged to be present in such an incredible, transformative period in people’s lives. And to be welcomed into their home and welcomed into a very intimate experience—it’s a birth of a mother and it’s the birth of the family. To be part of that sacred experience is amazing, and it does create these very special bonds.

What advice would you have for people thinking of becoming midwives?

I would encourage them to do their doula training—it’s quick, it takes a weekend. And I would also say to go to some births and see how you feel. It’s a great way to try on the on-call lifestyle of always having your cell phone on and being a half an hour from the hospital or somebody’s house. It’s a good opportunity to see how you deal with working nights and sleep deprivation. I would also encourage them to go into their local midwifery clinic and ask a midwife about what their life is like and the pros and cons of their midwife experience, and to see if they have opportunities for volunteers who could help with everything from putting together paperwork to helping facilitate the postpartum group for mothers.

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