Why Advocate?

We had our Annual General Meeting on Sunday via conference call.  It was an excellent meeting.  We elected a new Board with several new members, and discussed at length the activities we are involved in or developing, and pooled ideas for launching new activities or improving existing activities.

In the course of our discussion it was mentioned that most Canadians would question the need for a maternity care advocacy group in Canada.  Why would a country which sends medical delegates to other countries to teach them how to improve maternal and infant health need an advocacy group for improving maternity care within its own borders?  In a system that does so many things right, why do we need to get picky about what it does wrong?


It is true that Canadian infant and maternal mortality rates are low.  Maternal mortality is at 7 in 100,000.  Infant mortality is at 6.2 per 1,000 as of 2008 (Statscan).  Compare that with developing nations such as Afghanistan with 1,600 maternal deaths in 100,000 (Reuters) or Rwanda with 540 per 100,000 (UNICEF) and it is clear to see that we have a system that works and provides health and life to so many women and babies in Canada.  We have clean hospitals, universal health care that provides maternity care to all Canadians that require it, an obstetrical society to review research and make recommendations, and a mixture of options for women regarding maternity care providers from general physicians to midwives to obstetricians.  We have surgery for those births that require it.  We have tools to precipitate instrumental deliveries when needed (vacuum and forceps).  We have technology when we need it, and hands on care when we don’t.  Nurses who work in maternity are nearly always in love with their jobs; birth, babies, happy families~maternity nursing is the happiest kind of nursing there is!  Also, in the majority of Provinces/Territories, women have birth options.  We can choose our family doctor, a midwife, or an obstetrician as our primary care provider, and we can give birth at home or in the hospital.  A very few locations even offer the choice to give birth in a birth centre, which is a middle ground between home and hospital; equipped with large tubs and medical equipment, and generally within close proximity to the hospital in case a transfer of care is needed, but made to be cozy and homelike, and quite private.

So with all of these positive aspects of our system, where does an advocacy group fit in?  Why do we need one?  Where do we need improvement in our system?  What is there to complain about, anyways?

Birch Jean Smith, born in Vernon Jubilee Hospital, BC

Firstly, it is important to realize where we fit in with other developed nations as far as outcomes.  Sweden leads the way with Maternal mortality rates at 3 in 100,000 (WHO), less than half of ours in Canada. This difference is small but is considered significant.  The Netherlands also have a homebirth rate of 30% (Source) and are internationally known for their excellent health outcomes.  Canadian surgical birth rates soar above the recommended numbers, as cesarean rates in Canada push over 26%.

When surgical birth rates rise, the risks of surgery to women and infants rises until eventually more women and infants are being harmed by surgery than can be statistically justified.

There are other areas of maternity care which need improvement in our system.  In many situations World Health Organization or Society of Obstetricians and Gynecologists of Canada recommendations based on meta analyses of available research are not followed by health care providers.  Breech birth is still nearly always done by cesarean section, for example, despite SOGC recommendations having been changed in 2009 to show that vaginal birth is a safe way to deliver breech babies.  Vaginal Birth After Cesarean is subtly and overtly discouraged despite SOGC encouragement that it is safe and has high success rates, particularly for low transverse uterine scars and women with a history of one prior cesarean.  VBAC rates are abysmally low in Canada.  Instrumental delivery rates are higher than recommended.  Epidural rates are very high, carry complication rates that many are not aware of, and are often proclaimed by anaesthetists to contain drugs which do not to cross the placenta or affect the baby which is unsupported by research and simply not true.  Effective breastfeeding training as recommended by the World Health Organization is not universal.  Health Canada set a goal in the 1990s to see every hospital in Canada become designated Baby Friendly within a ten year period, but we have fallen far short of that goal: only five hospitals have been awarded Baby Friendly status in Canada (BFI), and most maternity wards provide archaic, conflictual, and inaccurate breastfeeding advice to women in the early days of breastfeeding, setting them up for eventual failure.  Breastfeeding is not rocket science, but it is a learned skill.  One whose success rates affect the health of women and babies in every community.

Another area which needs attention in our current Canadian system is acknowledgment of the emotional power of birth, and the vulnerability that birth opens up for women and babies.  Medical ideology tends to separate the physical and emotional aspects of humankind and undervalue the impact of emotion on overall health.  While birth is widely known to be an emotionally powerful time in a family’s life, emotion is not generally considered to be integrated into how birth happens.  In actual fact, a woman’s reproductive system is largely run via the parasympathetic nervous system, whose functions are suppressed by emotions such as fear, anger, feeling threatened, or an invasion of privacy.  In birth, emotion is as much a part of the physical process as muscle contraction.  This is largely unacknowledged by health care providers except for midwives in our current Canadian system.

A lack of acknowledgment of this fact opens women up to the possibility of emotional trauma as a result of how they are treated during the birthing process.  Some women develop postpartum mood disorders after emotionally traumatic births, and some are so severe as to progress into Post Traumatic Stress Disorder, impairing their ability to function within their families and larger lives for years afterwards.  This is indicative of how important the birth is to a woman’s psyche and emotional well being, and how important it is for us to treat birthing women with respect and gentleness as they give birth, always.  DONA international states that it is not how a woman gives birth that determines her emotional satisfaction with the experience, but it is her lack of a sense of loss of control during the process.  A woman can have every intervention possible in obstetrics and be safe from emotional trauma if she is involved in the decision making every step of the way and chooses each intervention and is emotionally supported throughout.  Nature designed women to become wide open emotionally during birth, and very spiritually open on purpose so that we would have the best chance of developing a deep bond with our babies and work to keep them alive and healthy.  If women feel violated during that emotionally open frame of mind they will remember it with clarity and deep feeling for the rest of their lives.

Because of these and other reasons, we need an unaffiliated party to advocate for best practices in maternity care in Canada.  No national, organized advocacy group existed prior to Mothers of Change, and we wish to join the voices of individual consumers of maternity care in Canada to fill that need.

What do you think?  What areas of maternal health care need reform or change in Canada?  How can we make women’s voices heard?  What do women want, when it comes to health care?  What does our system do well?  And where could it use advocates for improvement?