Midwifery: a policy win-win – Part I

Posted By William Stephenson – Mar. 10, 2014

When it comes to perinatal care, midwifery should be the norm, not the alternative. Not only do midwives provide extraordinary care, they do so at a fraction of the cost of obstetric care. Midwifery is a win-win for cash-strapped provinces: it’s good for the women under the care of midwives, and it’s good for the healthcare budget.

A personal perspective

My wife raves about the midwives who cared for her before, during and after our daughter’s birth. They were extremely knowledgeable, some of them drawing on their experience of having delivered over 800 babies, and they communicated this knowledge in a friendly, down-to-earth way. They were warm, empathetic and relaxed. Her visits took place in an inviting setting, dressed up with homestyle décor to avoid the cold, clinical feel. For post-birth visits, the midwives came to our home. Many of the midwives who cared for her had also had children themselves and could therefore directly relate to my wife’s concerns and offer her firsthand advice.

They managed to give this exceptional, very personal care despite the stressful dimensions of their work. Constantly on call, midwives have to try to avoid situations where due dates conflict. This can be difficult, since babies have a tendency not to arrive when expected.

More and more women seem drawn to seeking care from midwives. In our case, my wife was on a waiting list for a brief period of time before they confirmed that they could take her on as a patient.

Regulating midwifery in Canada

 This resurgence in interest in care by midwives comes after the profession relatively recently came out of a regulatory wilderness. While midwifery is a very old profession, it has often been viewed with traces of suspicion. From accusations of witchcraft in the middle ages to statements that midwives were unscientific and a “relic of barbarism” in the 20th Century, midwifery in Canada has been building its good name over the past 25 years.

Prior to the 1990s, midwifery was not recognized as a profession in Canada. Ontario was the first province to do so, in 1991, with amendments to the Regulated Health Professions Act and the passage of the Midwifery Act. Quebec began regulating the profession in 1999, while most other provinces introduced legislation in the 2000s. In provinces which regulate midwifery, a board or college of midwives oversees the profession.

However, the profession is still unrecognized in Prince Edward Island and the Yukon. And New Brunswick, which only established midwifery regulation in 2010, scrapped its program last year, claiming that it did “not seem prudent to introduce a new profession in the midst of systemic change.” Thus, the state of midwifery regulation in Canada is a patchwork at best.

In Ontario, on the other hand, midwives appear to have the government on their side. Ontario recently established two new birth centres, in Ottawa and Toronto, bringing its total to three, including the Tsi Non:we Ionnakeratstha Ona:grahsta’ Maternal and Child Centre located on the Six Nations territory.

Ontario is on the right track. Midwives, with their intensive four-year program, which involves a number of clinical placements, are well equipped to deal with non-complicated perinatal care. The profession’s culture of personal, nurturing care is aligned with the needs of the women they serve. And they provide this level of care at an incredible value. The average midwife in Ontario makes $65 000 per year. By contrast, the average total payments to an obstetrician/gynaecologist is well over $300,000. While the two are certainly not directly comparable, transferring more of the share of perinatal care to midwives would undoubtedly result in lower costs and happier mothers.

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In part II, I will canvass some of the legal and policy issues that are currently facing midwives, and explore potential solutions.

For more information:

Overview of midwifery and the law in Canada

Summary of provincial midwifery laws and regulations

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