CJ Blennerhassett: Growing Midwifery in an Area Where it’s Really Needed

Promo image for Healthcare Change Makers episode 48 with CJ Blennerhassett, Vice President of the Association of Nova Scotia Midwives and President Elect, Canadian Association of Midwives. Image of CJ smiling.

(Access show transcript) When the chance to return to her native Nova Scotia presented itself, CJ Blennerhassett jumped at it. As Vice President of the Association of Nova Scotia Midwives, she’s embraced the challenge to improve access to high-quality reproductive care in the province.

Show Summary

Our guest CJ Blennerhassett, began her career as a midwife in a busy Toronto practice. She has since moved back to her home province of Nova Scotia where there are just 16 midwives who deliver reproductive care in an area that has both urban and large rural pockets.

CJ is still a practicing midwife but now combines her duties with her role as Vice President of the Association of Nova Scotia Midwives and President-elect of the Canadian Association of Midwives. 

In those roles, CJ is honoured that her midwifery colleagues trust her to push health authorities, government, and decision-makers to think about creative solutions to the primary care crisis in Nova Scotia and across the country.

So many people in her province are without care, she says, while midwives are here and willing and excited about delivering that care.

Mentioned in this Episode

Transcript

Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers and what makes them tick. Welcome to Healthcare Change Makers, a podcast where we talk to leaders about the joys and challenges of driving change and working with partners, to create the safest healthcare system.

Ellen Gardner: Welcome to Healthcare Change Makers, a podcast produced by HIROC. I'm Ellen Gardner with Michelle Holden and Philip se Souza. Our guest, CJ Blennerhassett began her career as a midwife in a busy Toronto practice. She has since moved back to her home province of Nova Scotia where there are just 16 midwives who deliver reproductive care in an area that has both urban and large rural pockets. 

CJ is still a practicing midwife, but now combines her duties with her role as Vice President of the Association of Nova Scotia Midwives and President Elect of the Canadian Association of Midwives. In those roles, CJ is honoured that her midwifery colleagues trust her to push health authorities, government and decision makers to think about creative solutions to the primary care crisis in Nova Scotia. So many people in her province are without care, she says, while midwives are here and willing and excited about delivering that care.

Hi CJ, welcome to Healthcare Change Makers. It's great to have you.

CJ Blennerhassett: Hi Ellen, thanks so much. I'm happy to be here.

Ellen: Maybe we can start with your telling us what drew you to having a career as a midwife.

CJ: Sure. I'm happy to chat about this. It's one of my favorite things to think about. Well, it really started for me when I had my daughter. I had my daughter when I was a teenager, and it really wasn't until after I had given birth that I realized how much I didn't know or understand about the process. 
After my daughter was born, I really became fascinated with birth and I wanted to do whatever I could to ensure that others would have the opportunity to be educated about their bodies and about pregnancy and birth, and really mostly about decision-making throughout that process. So I found midwifery and the midwifery principles of continuity of care team, having those same people support you through the entirety of pregnancy, birth, and six weeks postpartum and really, especially the foundational principle of informed choice. Those things appealed really greatly to me.

Ellen: Did you have a midwife when you had your daughter or not?

CJ: No. Unfortunately, I gave birth at a time when midwifery was not yet regulated in Nova Scotia and there were no midwives practicing in the area where I had my daughter.

Ellen: It does sound like you are from Nova Scotia, but you moved to Ontario at a certain point. You'd worked at Kensington Midwives in Toronto. We're wondering what it was that drew you back to Nova Scotia.

CJ: Yeah, I left Nova Scotia to train to become a midwife and really enjoyed my time there. I lived in Hamilton and I lived in Stratford for a short time, and then the majority of my time I lived in Toronto. I think that experience of practicing in a jurisdiction where there are lots more midwives and midwifery is in lots of ways more integrated into the healthcare system, was very, very helpful. And so when the opportunity presented itself to be back here closer to family in Nova Scotia, I really jumped at that in order to be close to family, but also to participate in growing the profession in an area where it's really needed.

Ellen: You're the current President of the Association of Nova Scotia Midwives and a member of the Canadian Midwifery Regulators Council. I think you're also a midwife with IWK Health. So I would imagine you're spending less time delivering babies than you did in the past. How has the transition been from actually being very active frontline midwife to more of a leadership and an advocacy role?

CJ: It's been an interesting transition for sure. I actually became the Vice President of the Association of Nova Scotia Midwives in June. We have a wonderful new President, her name is Jessica MacDonald, and that's because I took on the position of the Canadian Association of Midwives' President Elect, which means that next year in June, I'll become the Canadian Association of Midwives' President.

And so that transition in lots of ways has been interesting to move from into that advocacy role and in some ways a regulatory role from that one-on-one clinical practice. But in Nova Scotia and in most smaller midwifery professional associations around the country, those associations function based on the labour of full-time practicing midwives. So all the work that I've done so far has been while practicing full-time. 

Midwives have volunteered their time to the association in Nova Scotia and others, like I said, across the country to promoting midwifery since long before midwifery was regulated in Nova Scotia in 2009. Having said that, I moved into this area of work because I really wanted to understand what the barriers were to midwifery growth in my home province. And I wanted to do whatever I could to support midwives here who've been working really tirelessly to serve clients despite being only 16 in number.

Ellen: The shortage of midwives does sound like a really pressing problem. Would you say that that is one of the main issues that you are dealing with now?

CJ: Absolutely. Unfortunately, in Nova Scotia, we turn away as many people as we take into midwifery care. We're really only able to care for about 50% of people who request midwifery care. Many members of the public, particularly those who could benefit most, don't necessarily know about midwifery care.

Ellen: What do you think are the roots of the shortage? Is it the fact that the schools aren't admitting enough women in training to become midwives or that the province itself doesn't have the infrastructure to support that kind of growth?

CJ: I certainly think having a midwifery education program here in the Atlantic provinces would be a massive first step. All of those who are from Nova Scotia or any of the Atlantic provinces who wanted to train to be midwives had to leave and travel significant distances at significant cost to obtain that training. So that lack of a training program here is one factor. 

And then another really just is government support and buy-in. We do have the demand. We have so many people in lots of places in our province who are requesting midwifery care, inquiring about it, demanding it from their local MLAs and their health authorities, but we don't yet have that government buy-in to commit to putting midwives in a diversity of areas of our province.

Ellen: Yes, because I heard you in an interview and you gave a really interesting statistic just talking about how in Nova Scotia midwives only do about 3% of births, while in BC it's as high as 25%. So it's really, there's high demand and yet it really is a dramatic difference in different parts of the country.

CJ: Yes, midwifery looks very different. And BC is doing really wonderful things. Part of that is because they have a model where they try their best to ensure the right care provider for the right patient at the right time. And what that means is primary care providers, midwives, and family physicians in BC are doing the bulk of that prenatal and intrapartum care. Whereas here in Nova Scotia, it's mostly far and away obstetricians. There are lots of family physicians of course who provide care and pregnancy during birth, but of not so many midwives and overabundance of obstetricians.

Ellen: Advocacy work is tough work, CJ. It's putting yourself in front of politicians and it's working on grassroots, activism. Is it something that you come to naturally or has it been a learning process for you becoming a voice and a face of advocacy in the province?

CJ: It's funny to be thought of as a voice and a face for advocacy in the province. It's not something I come to necessarily easily that role as a leader, but it's something that I really am honoured by that my colleagues have placed this level of trust in me. And really, I mean, I think about leadership just as being somebody who is speaking on behalf of the will of a group. So I hope that the folks who I work with would say that I'm not placing myself in a position of leadership to further my own goals necessarily, but to really push the health authorities, government, decision-makers to think about creative solutions to the primary care crisis in our province, because there are so many people who are without care and midwives are here and willing and ready and excited about caring for those people.

Ellen: Nova Scotia probably experienced a big influx of people during the pandemic as a lot of people left major centres like Toronto to either go back home to Nova Scotia or saw Nova Scotia as a great place to move to. So it does sound like the demand for home births and midwifery services would've gone up in the last few years.

CJ: We've certainly seen a huge population growth in our province. People are really excited to come live by the ocean and in the rural and remote areas that we have in our province, particularly during the pandemic. There is significant demand for both in and out of hospital births. So midwives in Nova Scotia do roughly 20% of our births at home or out of hospital. That number varies. So one of the practices that's more rural on the south shore, their home birth numbers approach about 50%. But anywhere from 50 to 80% of our births happen in hospitals. And in that way, we're able to contribute to helping with some of that demand that's been placed on hospital systems.

Ellen: Other than the shortage, what are some of the other challenges that Nova Scotia midwives face?

CJ: So as I spoke about, we really face in this province in a different way than some others, a lack of public awareness and understanding about our profession, and similarly a lack of interprofessional awareness of midwifery care. So we're really working hard at the Association of Nova Scotia Midwives and the Canadian Association of Midwives to remind healthcare providers, hospitals and health authorities as well of course as the government, that midwives are here as a solution to many of the issues facing our health system in Nova Scotia.

Another thing that we want to continue to remind people about and a challenge that we are working really hard at overcoming is the lack of Indigenous midwives in Nova Scotia and African Nova Scotian midwives. People in this province have to travel really great distances to access care in pregnancy and during birth. That's particularly true for Indigenous communities. 

We really want to see Indigenous midwives working in all Indigenous communities in Nova Scotia in order to not only bring birth and care and healthcare home to people in their home communities, but also to improve birth outcomes for those communities. We know that Indigenous midwives working in Indigenous communities is health equity and action.

Ellen: What are you doing to change that, encourage more Indigenous midwives and just change the whole diversity of the midwife population in the province?

CJ: Every time we speak to decision-makers, we're really trying to highlight the importance of not just growing midwifery, but growing Indigenous midwifery and growing the number and the visibility of African Nova Scotian midwives. There were for hundreds of years African Nova Scotian midwives who were caring for their people long before regulated midwifery was in place here in Nova Scotia. 

Another thing of course that the Association of Nova Scotia Midwives does is support the work of the National Aboriginal Council of Midwives. We are really blessed to have one of their co-chairs, Alisha Julien Reid, living here in the province. She's a Mi'kmaq midwife and she's doing fantastic work in communities in this province to increase access to high quality reproductive care.

Ellen: What have you learned, CJ, from people like her and other midwives who've been in the profession for a long time? How have those women impacted you and your career changes and growth?

CJ: I mean, I think when you learn to be a midwife in the Canadian context, a lot of the work that we do in learning this profession is about learning how to navigate and integrate into the health system, the reproductive health system, as it stands now. We have for decades been trying to increase the legitimacy and the respect for the profession and the availability of midwives. 

Since I've had the pleasure and the privilege to work with midwives like Alicia, other midwives at the National Aboriginal Council of Midwives and the Canadian Association of Racialized Midwives who have just formed, is really this kind of respect for slowing down and rather than trying to fit into those systems as they stand now, trying to focus on and support and continue to develop the skills and expertise, the uniqueness that midwives have. We offer a kind of care that is really unparalleled in this country, and that's something to be supported and celebrated.

Ellen: What we know about midwives is certainly that it's very much a team, a teamwork approach and that you delegate and you share work and you share ideas. Have you found that to be a natural thing for you as you're juggling being an active midwife and running the association and now moving towards more work with CAM? How are your delegation skills and are you realizing you really can't do it all?

CJ: My partner would really like me to realize that much quicker than I have to be truthful as evidenced by my full schedule. I mean, all of the work that I do, I wouldn't be able to do without other people. So nothing that happens at the Association of Nova Scotia Midwives happens because of me personally, it happens because of a group effort. And absolutely the same at the Canadian Association of Midwives. So it's really I'm just very lucky and privileged to work with people who are equally as committed to this work as I am. And yeah, I'm still working on that delegating thing.

Ellen: It's an evolving thing, but I guess comes more out of necessity than desire sometimes. You've practiced in Toronto, big urban centre, and of course now you're in a more rural area. There are some very distinct differences, smaller populations, but CJ, maybe you can talk about some of the real differences in terms of the work.

CJ: I work right now in Halifax Regional Municipality, which is considered an urban area though it's certainly massively smaller than my previous practice was in Toronto. I just want to acknowledge that because two of the practices in Nova Scotia are truly rural and their practice is really different in some ways as a result. But working now in a much smaller city with a huge, huge catchment area that does involve a lot of rural areas, I would certainly say that babies come out the same. Clinical work is the same. That's universal in lots of ways.

But I think what is different is the issues midwives face professionally, which are really mostly related to being a small workforce in a healthcare system, and I've touched on this previously, that has really yet to understand our potential. And this isn't all bad news. 

So midwives in Antigonish and on the South Shore, those two rural practices, they've established really excellent working relationships with other healthcare providers in their areas. They are considered to be an essential part of the provision of prenatal intrapartum and postpartum care in those communities. So that's really been wonderful to see that care for people in rural areas allows you to bring it to them where they're at. And that person, family and community-centred care is really foundational to midwifery in this country.

Ellen: What do you think is the biggest obstacle, CJ, to people really understanding the value that midwives bring to the healthcare team?

CJ: Ooh, that's a tough one to sum it all up in one obstacle because it's so multifaceted really. We have all the data. We have lots of evidence to tell us that midwifery care provides excellent outcomes for newborns and for parents, but we have yet to be able to impress upon the people who allocate resources in healthcare that that directly benefits not only their bottom line, we save the healthcare system money, but also benefits outcomes for people. And people, I hope, should be at the centre of decision-making in healthcare.

Ellen: Mm-hmm. The Canadian Association of Midwives' annual conference is coming up. We're just wondering what can delegates look forward to and what are you looking forward to at the conference?

CJ Blennerhassett: Ah, yes, it's coming up in less than a month here. It's running from November 1st to 3rd. And I am really looking forward to hearing from Jennie Joseph, who is the keynote speaker. Jennie's a Time Woman of the Year. She trained to be a midwife in the UK. And since that time, she's gone on to do a number of different things, including advocate for systemic reform that puts people giving birth and babies first in healthcare. She's worked in Europe, she's worked in the US. And she now is focusing a lot on the birth centre that she runs, but also on initiatives that educate the maternal and child healthcare workforce in order to address persistent racial and class disparities in birth outcomes. So I'm really, really excited about that.

There's also live presentations on topics like equity and healthcare. All of the live sessions have live interpretation into French for folks who speak French. Another exciting piece is that if you register for the conference and you can't attend on those days, all of those live sessions will be recorded and made available to registrants throughout the month of November.

Ellen: I'm curious, CJ, about it's been a few years since you chose midwifery as your profession and you've done so many different things and there’s is a real sense of growth in your career trajectory. How do you feel about the profession now compared to when you started and just everything that you've seen and all the changes? Is it a positive feeling or do you feel like, "Oh gee, there's so many more things we need to accomplish'?

CJ: I mean, there is so much more we need to accomplish, but the influx of creative minds into this profession, the like sheer volume of racialized midwives into this profession, all of these things are really exciting. 

We're moving into a phase right now, I think, where we're looking for midwives to work in all kinds of different ways. We're seeing different models of midwifery care pop up. So for example, there are midwives in Toronto who are prescribing medication abortion, who are looking after unhoused people in conjunction with obstetricians, who are looking after HIV positive parents, who are working with child protective services in order to keep babies with parents, who are working with family physicians, who are working with gynecologists to insert pessaries. There's just so many really creative models that are evolving based on this demand from midwives to have some work-life balance, avoid burnout, develop different skills. So that kind of flexibility I'm really loving seeing that all across the country.

Ellen: I'm sure you mentor a lot of younger midwives or newcomers to the profession. What is advice that you give to new midwives in terms of things they should be thinking about?

CJ: I think one thing that I have always felt really strongly about in terms of midwifery care and ways that it can benefit the healthcare system in lots of other areas is this focus on informed choice. One thing I try my best to stress with students is how we are coming to the client interaction in service of our clients, in service of patients, and in service of what they want. Our job is not to convince or cajole or ask our clients to fit into standards of care or the way the hospitals or health systems are used to doing things. Our role is to help the client navigate the system as best they can to achieve what their needs are. And I think really, unfortunately, that is not a perspective that is terribly common in our healthcare system. Not just here in Canada, but in lots of places around the world.

Michelle Holden: Hey CJ, it's Michelle here. I just been loving listening to this interview. I just really wanted to say congratulations on the upcoming position with Canadian Association of Midwives. HIROC works really closely with CAM so we're excited to see you on that front. You mentioned inspiring others and providers to think about creative solutions to primary care. I'm just wondering kind of aside from the BC model and the different examples you gave us, what are some of those creative outlets for you? Where do you look to for ideas?

CJ: I write and read fiction. I'm really inspired by people who blend that creativity with policy work for example. So just somebody like Stacey Abrams comes to mind who is a legislator in the United States and an advocate for voting rights reform, but who also writes fiction. And so I assume, I hope, the way that I think about it kind of goes to that place to re-energize and get your mind out of a lot of the policy work, which can be at times a slog. It can be exciting, but it can also be a slog. So certainly I go there. I also journal a lot and I watch a lot of reality TV, I got to be honest.

Michelle: I feel like I kind of crossed over into Ellen's lightning round. So maybe Ellen, you want to start in on the lightning round there with CJ? That'd be great.

Ellen: You know the drill. I just ask you a few quick questions and you give us the first thing that pops into your mind. So, first thing is, what are you reading right now?

CJ: Oh, I'm reading a really excellent graphic novel called Welcome to St. Hell: My Trans Teen Misadventure by Lewis Hancox.

Ellen: What is your secret talent, CJ?

CJ: Ugh, I don't know if dancing is secret, but I love to dance.

Ellen: How do you stay energized and motivated?

CJ: I spend time in my home, I spend time with my family, with my daughter, with my partner. One thing that really energizes me, and I know lots of midwives, is the opportunities that we have to gather together in person. And let me tell you, there is, at midwifery conferences, a lot of dancing.

Ellen: Yes, that's great. What's the best piece of career advice that you received?

CJ: You are not your opinion, which essentially means be open. Be open to new ways of looking at things.

Ellen: And if you could finish this sentence, If I wasn't in healthcare, I'd be working as a...

CJ: Lawyer. I guess the least exciting answer.

Ellen: Well, thank you so much, CJ. It's been a pleasure talking to you. Have a great conference and all the best in the year ahead for you.

CJ: Thanks so much for having me all, and it's been great.

Ellen: You have just been listening to our interview with CJ Blennerhassett, a practicing midwife and Vice President of the Association of Nova Scotia Midwives. For more information about HIROC and to listen to past episodes of Healthcare Change Makers, go to our website, hiroc.com. Thank you for listening.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website HIROC.com and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at communications@hiroc.com. We'd love to hear from you.