My first memories of motherhood are shaky. My body, pumped full of an opiate-and-anaesthetic cocktail, was exhibiting the rarely mentioned side effect of Caesarean drugs: uncontrollable shaking. My teeth chattered, and my hands trembled, and when the doctor placed my beautiful daughter on my chest, I experienced my first motherly worry: that my unsteady hands would betray us both. I’d had a Caesarean section after 27 hours of labour and three hours of pushing. Afterwards, I was wheeled into a tiny, stuffy hospital room where I tried to feed my newborn before a nurse swaddled her and set her down in a clear bassinet as I drifted into drug-addled sleep.  was dreaming I was on a sandy beach when suddenly an earthquake hit. The quake turned out to be the night nurse shaking my shoulders. “Wake up; your baby is cold,” she said, putting my daughter in my arms. “Warm her up and feed her,” she instructed. Before she left, she told me that if I couldn’t produce milk, I’d have to ask for donated milk. I had been a mother for less than two hours and already felt like I was failing.

Over the next few hours, nurses came in sporadically to remind me to feed my baby. They gave me pain medication and stool softeners, urging me to pee, poop and walk around. Their insistence was reminiscent of my staunchest Catholic-school teachers. Despite not feeling right, I walked laps around the nurses station, pushing my newborn in her plastic bassinet, crying as soon as I got back to my room because of pain, exhaustion and wild hormones. My walks signalled to the staff that I could go home 48 hours after my guts had been on an operating table. Even in my high state, I knew I was a physical and emotional mess and needed help. Four days later, I was back at the hospital with vision-blurring pain in my left side. I waited for hours, and when the doctor finally saw me, she smiled and said “Go home to your baby, mama” without investigating. Three years, an ultrasound, a round of pelvic-floor therapy and a pandemic later, the pain is still a constant, undiagnosed dull ache and a reminder that I regret not opting for a midwife.

Before I gave birth, I believed that doing so in a hospital would be a safe and supportive experience—it was one of the reasons I went with the on-staff obstetrician at my regular health clinic instead of a midwife. I also grew up being regaled with my mom’s idyllic-birth stories. She had two babies by C-section in the 1980s and stayed in the hospital for a week both times, resting and learning how to take care of her newborns. Her story isn’t unique—the 1980s was the heyday for maternal health care in Canada.

In the 1970s, the Canadian government was covering nearly 50 percent of total hospital and physician spending, improving the quality of care for moms and babies alike. However, the funds didn’t last. Federal health-care budgets were reduced by $30 billion between 1986 and 1996, and another $11.2 billion was cut by 1999. Following suit, the national average maternal hospital stay went from 5.3 days in the 1980s to 3 days in the 1990s and plunged down to 2.3 days for all births and 3.1 days for Caesareans in 2016. In 2019, I was out of B.C. Women’s Hospital in Vancouver 48 hours after my C-section.

Interjurisdictional-cost-sharing reforms over the decades have left our publicly funded system fragmented, failing many patients and frustrating workers, with nurses feeling the squeeze more than most. Calgary-area labour and delivery (L&D) nurse and lactation consultant Chelsey Goller says that nurses want to help much more than patient loads allow. “There are more patients per nurse now, so we can’t spend as much time with each,” she says of the cutbacks she has seen during her 15 years on the job.

A 2020 World Health Organization (WHO) report called the low supply of nurses a global issue. Even before the pandemic broke our fissured health-care system, Canadian nurses were reporting high levels of emotional exhaustion and depersonalization, meaning they couldn’t provide the care they wanted to. In a countrywide study conducted by the Canadian Federation of Nurses Unions in early 2020, nurses reported punitive work environments, burnout and concerns about the quality of patient care. Accounts from the dozens of Canadians I spoke to who gave birth between 1982 and this year illustrate the marked decline in maternal hospital care that started in the early 1990s.

As the lengths of hospital stays steadily decreased during that period, rooming-in—where babies stay in the room after birth instead of being taken to a nursery—became the norm. Rooming-in also helped buttress the Baby-Friendly Hospital Initiative (BFHI), a global endeavour to promote breastfeeding that was started in 1991 by the WHO and UNICEF. Elizabeth Brandeis, a registered midwife and the vice-president of the Canadian Association of Midwives, says that rooming-in, when paired with patient support, promotes infant-parent bonding and breastfeeding. If implemented properly, the BFHI practices could be incredibly helpful. As it stands, only 22 Canadian hospitals have successfully adopted the 10 steps required to receive the “baby friendly” designation, including things like ensuring staff have the skills required to promote breastfeeding.

Though many hospitals in the country have worked some of these steps into their practice, they lack the capacity to make the full shift, leaving wide gaps in which women feel left to their own devices. Emily*, who gave birth to four children in hospitals in Kitchener, Ont., between 1988 and 1996, experienced changes resulting from funding decreases and a move away from nurseries. In 1988, she was offered massages and was taught how to swaddle and bathe her firstborn. After having her second child, in 1992, her stay was just two days, and by 1993, when she gave birth to her third, the hospital was chaotic. “There were babies in the hallway,” she says. After her fourth, born in 1996, she was kept in hospital for a couple of days due to complications, but the nurses were around less. “They came in to do vitals and help me with feeding if I needed it, but otherwise I was on my own,” she says.

Rather than being cherished memories, many birth stories now remind mothers of feeling neglected by a system that was meant to care for them. Sidney* lost a significant amount of blood during the birth of her son in May 2021, and her four-day hospital stay in Kelowna, B.C., was enough to change her mind about having more kids. “You cannot be prepared for your first newborn, but to have no support or compassion from the nurses is traumatizing,” she says. “You start motherhood feeling like a failure.” Early-discharge policies are worse for babies too—when they came into effect in the 1990s, there was a 39 percent uptick in neonatal readmissions for issues like dehydration and jaundice, the latter being the case for Sidney’s son a few days after she was discharged.

Brandeis, who’s been a practising midwife for almost 20 years, has witnessed how many would benefit from medical alternatives. Promoting and establishing midwifery as central to prenatal and perinatal health care in Canada could vastly improve hospital birth experiences and provide needed support to those giving birth in rural and remote areas, where high rates of practitioner burnout and shortages are common. However, midwifery still has a long way to go. “Nearly 30 years after regulated midwifery first came into effect in Ontario, there are still a lot of misperceptions about who midwives are and what we do,” says Brandeis. For Anne*, a former midwife, nurse and mother from the U.K. who gave birth to four babies in Canada between 1982 and 1990, the seven-day hospital stays she had were a godsend. “The babies were rooming-in during the day, taken to the nursery at night, brought in for feeding during the night and taken away again,” she says. Her ability to sleep and recover made the transition to newborn care at home much easier. Anne’s daughter Talia*, who gave birth at B.C. Women’s Hospital in Vancouver in 2018 and 2021, knew enough about the current maternal-health-care system—from friends who’d recently given birth—to distrust it, which led her to opt for midwives. “In our era? Don’t ring the bell unless you’re dying,” she says.

Brandeis explains that many pregnant people circumvent the system by choosing a midwife. “Over the years, the care and resources that hospitals provide have been eroded,” she says. “Other than midwifery care, there really hasn’t been a community response or health-care option to fill that gap.” Care tailored to the individual needs of the patient is a central tenet of midwifery, which is part of why there’s a strong need for it in Indigenous communities too. Indigenous midwifery was erased by colonialism, and there’s been a push in recent years to restore the sacred position its practitioners once held. As of 2019, the National Aboriginal Council of Midwives has more than 120 members.

Though she’s an L&D nurse herself, Goller opted for midwife care with both of her own pregnancies, and so did most of her co-workers. “It’s very telling that we knew that in hospital you basically get booted out and then you might get one home visit from a public health nurse,” she says. “With midwives, it’s totally different—they visit you for the first week at home. They give you better support, and we wanted that.” In the U.K., where midwifery is more mainstream, there’s a saying Brandeis is fond of: “Everybody needs a midwife, and some people also need doctors.” Many Canadians I spoke to who had horrible experiences with hospital care after their first birth opted for a midwife for subsequent pregnancies, though these choices aren’t often talked about. We tend to keep details about traumatic births to ourselves for fear of letting it be known that our child coming into the world wasn’t the most magical day of our lives. It might’ve been, had we received better care. Talking about the realities of childbirth can empower those of us who have gone through it or will in the future. As well, being honest about our medical experiences shows that we love our children enough to want the system that’s designed to care for them to improve.

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