Janice McCaskill has had a lifelong dream of baby catching. Unfortunately the road to where her passion lies has not been an easy one. After years of studying and attending clinical placements in the U.S. while raising a family, McCaskill is about to complete the final steps to be able to practise in Saskatchewan.
As a foreign-trained midwife, she was required to attend an assessment program for internationally trained midwives in order to be eligible to practise in Canada. After spending three months in Toronto at Ryerson University in the International Midwifery Pre-Registration Program (IMPP) for the first phase of her assessment, she will soon be starting her three-month clinical placement in the Saskatoon midwifery practice, seeing clients for clinic visits as well as attending home and hospital births.
From there, she'll be eligible for a conditional license to practice here in Saskatchewan until she passes the national midwifery exam that all midwifery graduates have to write, and eventually will apply for full registration as a registered midwife with the Saskatchewan College of Midwives.
Her plans are to stay and work in the province providing there are jobs available when she is finished. However, as of now, the only health regions employing midwives are Saskatoon, Regina and Cypress Hills. Janice maintains, when Heartland Health Region moves to a decision to employ midwives, she would consider moving back to this area.
I posed several questions to McCaskill to learn about the program she has been working on.
What could readers know about midwives?
"Midwives are specialists in normal birth and support women who give birth in the setting that they are most comfortable in, whether that is at home, hospital or birth centre. We study at university level for years and have to maintain high standards for our skills and knowledge in order to practise in Canada.
"To debunk a common myth, midwives are not "anti-doctor" or "anti-hospital" but do believe that pregnancy and birth are not diseases to be cured but natural life events that don't usually require the care of a specialist or a lot of medical intervention. We provide care to the mother and baby throughout pregnancy, during the birth and for six weeks after the birth.
"We are trained to recognize when a situation is outside the range of normal and we then consult with a physician or transfer to hospital in the event of a homebirth. To handle emergencies, we carry resuscitation equipment and medications, and maintain certification in CPR, emergency obstetrical courses and neonatal resuscitation. Midwives in most provinces, including Saskatchewan, can obtain hospital privileges to be able to admit and treat clients in a hospital."
What roadblocks have you faced?
"The biggest roadblock has been access to clinical experience in my own province and country. Because my midwifery program was a distance education program, it had students from all over the world and the program wasn't able to offer liability insurance to students in so many different countries. Being enrolled in a foreign midwifery program without liability insurance meant that I wasn't able to do clinical work in Canada."
When did Saskatchewan finally open up to the option of practicing midwives?
"Women had been lobbying for midwifery services in Saskatchewan to be publicly funded and regulated for many years and The Midwifery Act was proclaimed in 2008. Saskatoon was the first health region in the province to set up midwifery services. There are still only three health regions in the entire province that offer midwifery services, and there are 11 midwives registered and working in the province.
"Saskatchewan chose an employee model for midwifery practice so the midwives are employed through the health regions and are limited to practise within that health region. Each midwife attends home and hospital births as the primary care provider for her own clients, plus she attends home and hospital births for her colleagues as a 'second' midwife. Each birth requires two skilled attendants, whether in home or hospital. In Saskatchewan, the 'second 'can be a nurse in the hospital, and Saskatoon Health Region has recently hired people who are trained to be 'second attendants'. These second attendants have CPR and NRP skills, and can be health care workers such as EMTs, doulas or student midwives."
How long is a typical midwifery education program?
"A Canadian midwifery education program is a four-year direct entry university program and results in a bachelor of science in midwifery.
How challenging has it been all of these years trying to raise a family and be a student in this course?
"It's been a huge challenge. I've had to be very creative in carving out time to study time to finish my degree; studying late at night, while nursing a baby or with a toddler on my lap. I've also worked part-time to help pay for tuition and travel costs associated with my U.S. placements.
As a mom, I've often felt torn between pursuing my dream of working as a midwife and wanting to be home with my kids. It's been very difficult to have to leave my children for any length of time so that I can do clinical placements in the U.S but my husband has been incredibly supportive and I've always had the support of my friends and family - I could never have done this without them. At the same time, I think it's a good lesson for my daughters who have seen me struggle and work so hard to finish school and become registered and I hope they pursue their own dreams regardless of how challenging it is for them."
What has been your biggest challenge as a Sask. resident wanting to pursue a career being a midwife?
"Our population in Saskatchewan is small and very spread out, so it was hard to organize politically to lobby for the regulation and implementation of midwifery, and it took a long time to finally get the legislation to regulate and implement it! And there's no education program here, so that meant I would have had to leave the province to pursue an education and I knew that if I went to the work of relocating my family for at least four years in another province, I would be reluctant to do it all again to move back, so I made the decision to stay here in Saskatchewan and do my education by distance."
What, in your opinion, is the stumbling block for the Saskatchewan government to implement licensed midwives?
"Well, they've already started to implement midwifery in some of the health regions. Like a lot of other health care professions, it's money and resources. It costs a lot of money to establish a new profession in each health region, and then it's difficult to recruit the few Canadian graduates we have, to come to Saskatchewan after they've completed their education in another province."
With rural hospitals doing less and less deliveries, would you be able to practise in a community like ours or would you have to move to a larger centre?
"Since our local hospital has a policy to no longer do deliveries, I wouldn't be able to work out of Unity hospital unless they started allowing births again and I'd have to apply for privileges. In Heartland, Rosetown and Kindersley are the only hospitals I could work out of if and when Heartland chooses to offer midwifery care. More and more women have to go to larger centres to deliver and those centres can't always handle the influx of patients who need to deliver so I'm hoping that district and community hospitals return to, or remain being an option for women to deliver in.
