Profile: Kootenay Community Midwives, Nelson, BC

Midwife Tanya Momtazian with her baby, Shayan.

Kootenay Community Midwives (KCM) is a small practice with three midwives. It has served expectant mothers and their families in Nelson, BC, as well as the surrounding communities, since 2000, when midwifery became a formally registered practice in the province.

Unlike most rural midwifery practices, KCM operates as a “shared care” model, which means that expectant mothers are looked after by all midwives in the group. Deliveries are attended by the midwife on call. If a midwife has spent a long period with a woman during delivery, the other members of the practice will relieve her and see to her other patients so that she can rest and recover. This type of support is extremely important within the practice because midwives – unlike physicians – do not have a rural locum service in place yet. The Midwives Association of BC (MABC) recently received funding to pilot a rural midwifery locum service, but is still looking for ways to establish sustained funding and secure participants for the program.

While the shared care model is not unique to KCM, the group is distinct in that it works interprofessionally with family physicians and obstetricians in Nelson to provide rural obstetrical care. The midwives have privileges at Kootenay Lake Hospital and work closely with paramedics, nurses and specialists in the region to ensure that birthing mothers receive safe primary obstetrical health care while pursuing a positive birth experience. KCM’s approach is quite successful – the midwives attend more than one-third of the births in the region, well above the estimated annual provincial midwifery delivery rate of 14 per cent.

KCM has worked extensively to create cooperative relationships with public health nurses to provide obstetrical care coverage to smaller, more remote communities in the surrounding area. According to KCM midwife Tanya Momtazian, this year, approximately 50 per cent of births in the Kootenays will occur outside of Nelson. While the midwives will conduct home visits where they can, long distances to smaller communities combined with hazardous winter road conditions present challenges, so the group works with local public health nurses and local clinics to oversee the health of the mothers. “To drive an hour and a half over a snowy pass just to do a baby weight [measurement] is not very good,” notes Momtazian. “We’re trying to find ways of addressing that better.” Occasionally, the group will conduct a clinic if there are enough expectant mothers in a smaller community to warrant it.

In addition to prenatal and delivery care, KCM midwives also provide post-partum care up to six weeks after delivery. In rural parts of the Kootenays, midwives may be the only primary care provider looking after the post-partum health of mom and baby. Momtazian notes that funding cutbacks have resulted in public health nurses focusing on first-time mothers – home visits with women who have delivered a second (or more) child are becoming infrequent. “We do the full range of post-partum exams, checking for any signs of post-partum depression, looking at stitches and incisions.” The midwives also follow up on other post-partum healthcare services, like breastfeeding support.

In the midst of this full workload, KCM has still managed to find time to conduct a community-based research project. Momtazian recently worked with an interdisciplinary group of professionals, Selkirk College nursing students and with the local GP Community of Practice to find out what infant feeding supports are needed, liked and wanted in the West Kootenay region. They’ve conducted an initial survey to measure the responses and have yet to do the analysis. Based on the results, KCM – along with other local maternal health providers – will try to determine how to improve their service delivery. “Once we do the analysis and actually come up with ideas for improving services, then I think that’s when we’re going to start looking for the funding to make it happen.”

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