Rural Midwifery in Alberta

In our new blog segment, the Alberta Association of Midwives is sitting down with midwives and other care providers throughout the province for an inside look at midwifery in Alberta and the important topics that make our profession unique, personal and compelling.

Tarina Mosley is a rural midwife in Drayton Valley with West Country Midwives. Tarina has served families across Alberta and even The Northwest Territories and completed a Bachelor of Science in Microbiology from The University of British Columbia before pursuing the Midwifery Education Program at Mount Royal University. Tarina enjoys the rural life living on an acreage with two dogs, a cat, horses, and a husband!

Tarina is incredibly grateful to bear witness to each and every birth and is passionate about empowering clients to be at the forefront of the decision-making process throughout their pregnancy, birth, and the postpartum period. 

Today, we're sitting down with Tarina to learn more about rural midwifery, why it matters, what challenges rural birthing people are facing in our province and what we can do about it.

Hi Tarina, it's a pleasure to be able to connect with you today! Why has midwifery traditionally been important for rural communities?

I believe that rural midwifery is incredibly important due to the lack of available resources in these communities. For example, in the community I primarily work in, the hospital does not offer birth services. Therefore, client's traditionally have had to travel over an hour for prenatal and postpartum care at different points in their pregnancy. Not everyone has the available resources to make these frequent trips, so having midwifery in the community allows for these folks to access these resources readily.

What is your favourite part about being a midwife for rural communities?

My favourite part of rural midwifery is community – with such a small town, you know your clients very well. People hear about your midwifery services through the grapevine, and you are well-integrated into the rural hospitals. I am always having new folks in care who in some way or another, are a sister/friend/cousin, etc., of a previous or current client. It feels great to service a community and be a part of this community in such a manner.

What does "empowered birth" mean to you?

For me, empowered birth means that clients are fully informed of the options available to them. It means that the most up-to-date research is presented so clients can make the best choice for themselves. At the end of the day, they feel empowered in their decisions and, in many ways, can take back the 'power' that was taken from them with previous birthing experiences.

What should clients in rural communities expect when they choose:

• to birth at home – This is largely dependent on the distance to the closest obstetric facility. Folks make a decision in rural communities to give birth at home based on their experience with previous births, winter weather, and their distance from an obstetric facility should they require emergency services.

• to birth at a birth centre – West Country Midwives offer birth centre options both in my primary community of Drayton Valley and the Rocky Mountain House suite. We have a lovely birthing facility in Rocky Mountain House which is only a few blocks away from our primary hospital. This is an excellent option for folks who have concerns with the drive and  distance with birthing at home but are hoping for a more intimate out-of-hospital experience.

• to birth at the hospital – We are very lucky in our community to be so well integrated into the hospital. We have a level 1 facility in Rocky Mountain House with c-section and epidural capability. There are no NICU staff at this facility. There are two labour rooms within an acute care unit, and there is one Operating Room available. We do not have on-site Operating Room staff after hours, but we have folks who are on-call for emergencies and cesarean sections.

• Are hotels a birthplace option for rural clients? Yes, hotels are an option for rural clients, but folks mainly utilize our birthing suites. Due to distance, some clients will choose to stay in a hotel during early labour to be closer to facilities.

What is the biggest misconception people have about rural midwifery?

I have yet to hear many statements about rural midwifery that are misconceptions, but we do a lot of driving, and roads can often be bad in the wintertime. We don't necessarily have access to all of our required resources within a timely manner or readily available staff in the hospital (we often rely on each other). That is, unfortunately, the hazards of working and living in these communities.

What challenges do birthing people in rural communities face?

The main challenges birthing people in rural communities face are;

• Driving distance to facilities, including ultrasounds and specialist appointments.

• Poor knowledge of obstetrics in local facilities which don't offer obstetric services.

• Poor winter road conditions.

• Distance for birth, anxieties surrounding 'making that drive' in labour.

What is your favourite "rural birth story"?

My favourite rural birth stories are those which include large families birthing together at home on rural farms. The children are encouraged and involved throughout the labour and birth, and siblings wake up in the morning to meet the new addition! There might be other family members there making food and offering support. We might have a pool set up outside or utilize the land for walks and as a form of distraction. There might be cows and pigs and horses and a variety of other animals. These are some of my favourite births!

How can birthing people advocate for more resources in rural communities?

Write to your local MLAs and politicians. Write to newspapers and news facilities. The more we can spread the word, the more we can get the knowledge out there regarding the lack of available resources in these small communities.

How can we improve access to midwifery care in rural communities?

The big piece is finding graduates and midwives who are willing to work in these communities. There are job openings in several rural communities throughout Alberta, but unfortunately, most grads and midwives who are new to the province prefer to work in larger centres. I would say the big piece is educating student midwives in rural midwifery – offering placements and incentives for student midwives to complete placements in these locations. Leaving spots available in the program for those who come from rural communities is also key. Often if someone has lived in a rural community prior, they would be more likely to work rural following graduation. And lastly, incentive to work rural such as student loan program forgiveness and relocation/housing incentives.

What is an issue facing pregnant/birthing people that needs to be talked about more?

Previous birth trauma and experiences. I have many folks who have trauma from a previous birth that was never properly addressed. Often times their feelings are not validated, and proper counselling routes are not recommended. We need to offer support and resources to these folks to debrief these traumatic experiences.

Finish this sentence: Because of rural midwives, birth is being brought back to communities where it was once taken away.

The Alberta Association of Midwives promotes the growth and sustainability of midwives and midwifery services in Alberta. We tell the stories of midwives in our province so that the profession of midwifery is understood, respected and valued in our communities.

If you have a story to share about midwifery in Alberta, connect with us to be featured in a future blog post.