What comes to mind when you hear the term "midwife"?
If you picture a Birkenstock-wearing, New Age woman who advocates only for medication-free home births in a bathtub, you have some catching up to do on your knowledge of 21st-century obstetrics in Canada.
Midwives are licensed practitioners who specialize in caring for women through pregnancy, delivery and post-partum.
They neither push for, nor advise against, using medication during labour, and about 75 per cent of midwife-assisted births in Canada take place in a hospital, according to the Midwives Association of British Columbia.
"We don't push anything," says Tracy Simpson, a registered midwife. "We do the opposite of pushing. That's the key part of midwifery - the clients make their own choices."
At New West Community Midwives, where Simpson and her colleague Lindsay Brimblecombe run their practice a block from Royal Columbian Hospital, client Maggie Lai and her partner Johann wait with their 14-month old daughter Elise for a checkup.
The Lai family chose to go with a midwife for their first child and are back again for their second.
"This was one of the smartest decisions I've ever made," says Maggie. "Tracy and Lindsay have been extremely supportive, even after Elise was born."
Sharon Tan, another client who is back for her second pregnancy, says the main benefits of having a midwife include not feeling rushed during an appointment, and the personal attention and support offered.
Tan had to have an emergency C-section and appreciated that Simpson was there to support her through the procedure.
"It's great to have your husband there, but having someone with experience, too, is nice for the both of you," she said.
Because there are fewer intervention rates with midwifeassisted births, as well as shorter hospital stays and more home births, the cost to the medical system is decreased, Simpson said.
A woman who gives birth in hospital without a midwife will typically stay for 24 hours after delivering her baby, whereas a woman who uses the services of a midwife might go home four to six hours post-partum, she noted.
And a woman seeing a regular doctor will generally be seen only a week or two after delivery by a nurse, whereas a midwife will visit a woman three to five times in that two-week period.
New mothers, especially, have many questions, and Simpson says being available to her clients around the clock is important to ensure they and their newborns are well cared for.
The two most common concerns she hears?
How to properly breastfeed and general health-care questions.
"We get a lot of midnight phone calls about bleeding belly buttons," she said.
With so many valuable aspects to having a midwife, why would anyone not choose to go with the service?
Other than for women with highrisk pregnancies, Simpson says it's basically just a lack of awareness about what's offered.
"We do the same things (as doctors), we just do it differently," she said. "We're educating people. We don't just hand them a form and say, 'Go fill this out.'"
Angie Dodd, another client at New West Community Midwives, had her first baby under the care of her family doctor. She is now pregnant with her second child and is happy to have followed her friends' advice to choose midwifery this time.
"They're more conscientious and detail-oriented than a doctor might be," she said. "So peace of mind is there. The minute something is a bit off they're like, 'Let's just check,' rather than waiting to see."
Midwives can order the same tests as a family doctor - genetic screening, blood tests, ultrasound - which means it's not necessary to see both a midwife and general practitioner during a normal pregnancy.
Perhaps one of the biggest misconceptions about midwifery is that it is an expensive service.
In fact, it's fully covered by the Medical Services Plan.
As long as a woman has a valid MSP number she is entitled to make use of the service of a midwife.
Finding one, however, can be a challenge.
At her New West practice, Simpson says she and her two colleagues are booked through to next January, though they do take new patients and keep a waitlist.
Since 1997, midwifery has been regulated in this province by the College of Midwives of British Columbia.
There are seven midwifery schools in Canada, including one in B.C.
To become licensed, a practitioner must complete a four-year program at one of these schools and then pass the exam that qualifies them to register with the college.
There are currently 120 registered, practising midwives in B.C., and the demand is growing steadily, especially in more remote regions of the province.
As such, the provincial government recently announced plans give a $2 million investment to the midwifery education program at the University of British Columbia. The funding will double the number of students admitted into the four-year program, from 10 to 20 by the 2014-2015 school year.
Since the midwifery program started at UBC in 2002, more than 100 people have applied each year for the 10 first-year spaces available.
Simpson said for anyone considering a career as a midwife, it's helpful to have a keen interest and capability in the medical field, as well patience, intelligence, possibly a degree, and previous life experience.
"Having kids helps," she says. "It's not required, but it helps."