The COVID-19 pandemic has caused some expectant families to feel wary about planning for birth in the Yukon’s hospitals, causing an uptick in interest in midwifery services.

“In the first few weeks of COVID, I had more requests than I’ve had in the past year,” said Kathleen Cranfield, the president of the Community Midwifery Association Yukon. “I have had numerous requests from pregnant people looking for an alternative to the hospital.”

Midwifery is not currently a part of the Yukon’s medical system, and Cranfield is working with the territorial government to implement draft regulations and license midwives.

The government is aiming to implement midwifery in the fall of 2021.

Though the Yukon has no active cases of the virus, new rules are in place at hospitals that have changed the landscape for expectant families during the pandemic.

Pregnant women are required to attend ultrasounds and check-ups alone. During birth, they are permitted one support person.

Entonox nitrous oxide is not being offered for pain management.

Cranfield said these new rules are in line with recommendations across the country.

Cranfield said she wants to reassure expectant families that hospitals are a perfectly safe place right now, especially given the Yukon’s positive standing with zero active cases.

“The hospital is not a dangerous place to have your baby right now,” Cranfield said.

“We’re not at the same phase as it’s happening in Montreal or Toronto … now, there is no reason to be nervous and scared.”

While the Yukon is currently in a good position, Cranfield hopes that midwifery regulations will be implemented this year to prepare for the possibility of a future outbreak.

“It’s important to have that long-term lens, and think about keeping healthy people separate from hospital where sick people are,” Cranfield said.

“That’s been acknowledged by governments across the country and therefore looking at midwives as essential care workers to offer that option.”

In an emailed statement to the Star, Clarissa Wall, the health communications director, said the government is endeavouring to continue work on licensing midwifery.

“The regulation, funding and implementation of midwifery as a safe additional option for birthing in Yukon remains a priority,” Wall said.

Wall explained that this implementation is reliant on collaboration among physicians, nurses, Emergency Medical Services, midwives and the Yukon Hospital Corp.

“Many of these key stakeholders are closely involved in COVID-19 response planning, so we continue to look at health system capacity every few weeks to determine to what extent we can continue to move things forward for the implementation of midwifery in Yukon,” Wall said.

“Although some of our work on midwifery has been impacted by COVID-19, we continue to move forward.”

Wall said there is active planning for the “current and hypothetical future scenarios” of the pandemic in this context.

Cranfield said she is cognizant that the COVID-19 response is a necessary priority for the Health department, but hopes it won’t delay midwifery implementation longer than is necessary.

“Because it’s important to continue to use the long-term lens with the novel coronavirus, that it could potentially resurge, and it would seem like a responsible priority to maintain the work,” Cranfield said.

“Midwifery care is, by evidence, proven to be safe and effective and the option of home birth has also been proven outside of COVID to be a safe option for birthing people …. I say this needs to be a responsible priority maintained, because I do think that given such a safe option, of course we need to integrate responsibly.”

Cranfield reasoned that there is already a base interest in midwifery in the territory, with the pandemic only compounding that interest.

Cranfield is not currently offering home births in the Yukon, and is planning to travel to Fort Smith, N.W.T., this summer to offer locum provision there.

“It’s hard for me to work here,” Cranfield said.

“I aim to be part of the solution, and I don’t want to be offering, and feeling that responsibility, to offer those home births without it being integrated into the system with regulations in place.

“I don’t want to offer my services and make the system feel uneasy, but I also feel an obligation to people who are wanting the out-of-hospital option, so it’s a tough spot to be.”

Christina Kaiser is currently the only midwife offering home births in the territory.

She has also seen an increase in interest from Yukoners since the pandemic began.

The lack of implementation, however, has made midwifery services prohibitively expensive for most families.

“I think if midwifery were regulated and funded, it would look different,” Kaiser said.

“We would probably have more people asking for home births so they can stay in their own environment.”

According to Kaiser, while the hospital is a safe place, the new rules during the pandemic are distressing for many families.

The limit of one support person during birth, for example, prohibits pregnant women from being supported by their chosen network. Most birthing mothers choose their partners to be present, Kaiser said. This excludes doulas, mothers and friends from also being in the room.

“All the studies point toward that having another woman at your side as your support person makes a huge difference to the birth and the outcome and to the family,” Kaiser said.

“So, having a support person there, other than the partner, is very important for a lot of families.

“It’s very hard for women to have it this way, and there are many women who are upset about it.”

It’s also been challenging for expectant mothers to attend ultrasound scans alone, due to COVID-19 rules.

“That’s something that in our culture has become a family celebration,” Kaiser said.

“The partner can’t go to the ultrasound to see the baby and that’s very upsetting for families.”

Some expectant families might prefer a home birth because it would mean that family and friends could visit from a safe distance, something that is not currently possible at hospitals, Kaiser said.

“It’s hard to be pregnant during the pandemic and there’s a lot of uncertainties and what-not,” Kaiser said.

“What’s the same is, we still have the same dedicated people taking care of the families.”

Tuesday was the international day of the midwife, according to the International Confederation of Midwives. This year, the theme was “Celebrate. Demonstrate. Mobilise. Unite.”