Midwifery: Legal and Policy Issues – Part II

Posted By William Stephenson

In Part I, I discussed the regulatory environment in which midwifery exists. Here, I turn to three more specific legal and policy challenges that midwives or aspiring midwives face.

Liability and Professional
As healthcare professionals with full responsibility for care before, during, and after birth, midwives are exposed to liability for any departure from their professional standards. When complications arise, midwives must transfer patients and ensure that they receive continuous care. Midwives must also give their patients sufficient information to make informed choices about their care. This places a significant burden of responsibility on midwives – a responsibility for which they rarely receive recognition.

In SS v SD, tests revealed that the patient had gestational diabetes that required insulin treatment. The midwives told the patient that this was beyond the scope of their practice and that she should seek care from a hospital that could offer the appropriate care. The midwives eventually terminated their care of the patient.

Based on an investigation, the Ontario Health Professions Appeal and Review Board found that the midwives had not provided the patient with adequate information to make an informed choice about her care. It also found that the midwives terminated their care “without reasonable cause and without adequate notice,” which resulted in a discontinuity of care.

This case illustrates the extent to which midwives are subject to liability – an inevitable fact of the profession. However, few professions are as heavily exposed to liability while at the same time being as undervalued as midwives.


A little more pay goes a long way
Considering midwives’ exposure to liability and the medical expertise required in their profession, one might expect that midwives’ salaries would be reflective of their level of responsibility. However, the average salary for a midwife in Canada is $65,000. Taking into account the responsibility, knowledge, and exposure to liability midwives face, $65,000 seems low, especially given that the average physician earns around $225,000 after taking into account overhead costs.

Speaking to the CBC, midwife Crystal Hall noted: “When we first started, we were funded to provide women in low risk normal settings, provide care from the beginning of the pregnancy right to the end … [n]ow, we’re prescribing more medications. We’re just doing way more than we were funded for.”

After years of lobbying the Ontario government for more pay, the Association of Ontario Midwives launched a Human Rights Tribunal complaint for greater pay equity. Their complaint is based on gender discrimination, given that the profession is female-dominated. It also relies on a report by Paul Durber, in which he found that the value of midwives’ services is about 91% of what family physicians are paid. Currently, their pay is about 52% of a family physician’s.

While the details of how much more midwives should be paid is debatable, they deserve to be paid much more than they currently receive. Cash-strapped provinces can make this work by emphasizing midwifery over obstetric care for normal pregnancies, since this would mean obstetricians would bill less. Midwives’ salaries, on the other hand, would still remain below physicians’ pay, resulting in net savings. Furthermore, the demand for midwifery services already exists – 40% of women who seek midwifery care are turned away because of the shortage of midwives.

Licensing & Education: Penury of Programs
Midwifery is not an accessible profession in Canada. This is especially true given the small number of midwifery programs in Canada, and their irregular locations. It would be hard to meet the demand for trained midwives if greater emphasis were to be placed on midwifery as an option for pregnant women. As it stands, the supply of midwives can barely keep up with the demand for their services.

There are seven midwifery programs in Canada, but five provinces do not have any midwifery programs at all. Three programs are in Ontario, while the other four are in British Columbia, Alberta, Manitoba, and Québec. A number of these programs are in less populated cities: Trois Rivières (the only program in Québec), Sudbury, and The Pas (the only program in Manitoba). Additional programs in larger urban centers would make it easier to pursue a career in midwifery.

It’s time we recognize the value of midwifery both to the women they care for and to the provincial healthcare systems they operate within. Midwifery is a policy win-win. It’s time our healthcare system embrace this reality.

Getting to Know the MJLH, vol 9: Katarina Daniels, Executive Online Editor

Posted By Katarina Daniels

What is the best part of your role as Executive Online Editor of the MJLH?

Learning from my peers. The Online Board dedicates itself to bringing the latest in health law, policy, and ethics to MJLH followers, and our editors are constantly surprising me with the impressive range of topics they choose to cover, as well as the high quality of their work as writers and editors. I can’t wait to see what the Volume 9 team produces this year!

What did you do this summer?

Lots of traveling (and a bit of school and work)!

In May, I was lucky enough to be one of ten students – along with Jen Anderson, the MJLH Editor-in-Chief – chosen to participate in the McGill-Shantou Summer Law Programme in Shantou, China. Despite the short duration of the trip (just 2 weeks), we learned a great deal about the Chinese legal system, Chinese arbitration systems, the Chinese approach to disability law, and legal education in China. It is an experience that I will carry with me always, and I highly encourage all McGill students to apply to the program!

Upon my return, I started a legal clinic placement at Chez Doris, a day centre for women in difficulty. It was my first real hands-on legal experience, and a very valuable one at that! I wrote letters to landlords and neighbours, I prepared flyers on topics including landlord-tenant relationships, bed bugs, and legal aid, and I got to accompany clients to Legal Aid and to the Régie du Logement, among other responsibilities.

During my placement, I also took two vacations: a 4th of July trip to Chicago (home of the best burgers ever – check out Kuma’s Corner), and a two-week trip to Malaysia and Hong Kong. Both vacations, highly recommended. Necessary R&R before starting 3L!

Quelles sont vos ressources préférées pour les nouvelles de la santé?

Mon application Twitter est toujours ouverte pour que je puisse “re-tweeter” et faire des commentaires sur les nouvelles de la santé. La RDSM suit: @Ghealthrights, @IMHLMcGill, @ONThealth, @ILOHealthcare, @McGillMed, @healthcouncilca, @worldbankhealth, @GenomicsPolicy , @AMaioni, @EU_Health, @nprGlobalHealth, @Health_Care_Law, parmi beaucoup d’autres.

What attracted you to join the MJLH?

Health law is so relevant and omnipresent, and yet we rarely discuss issues relating to health care in first year law. After all the theory in 1L, I desperately needed to see real-life, current applications of the concepts I was studying. I have absolutely no background in health law or policy, but I started following the MJLH on Facebook and was really interested in some of the news articles that they posted. That’s when I looked into the Online Board.

Quels sont vos festivals d’été préférés de Montréal?

Le Festival Juste pour rire – je l’ai manqué cette année parce que j’étais en Asie, mais normalement j’assiste aux spectacles ‘Off JFL,’ qui sont moins chers mais également amusants. J’ai aussi beaucoup aimé les festivals pour le Grand Prix: je suis allée au Festival sur la rue Crescent, mais aussi celui sur la rue Monkland, à NDG. Je dirais par contre que je les aimais plus pour les food trucks que pour les autos!

Getting to Know the MJLH, vol 9: Samantha Allen, Executive Managing Editor

Posted By Katarina Daniels

What is the best part of your role as Executive Managing Editor of the MJLH?

I really enjoy working with a broad range of students, who become a great team, on topics that are important from an interdisciplinary perspective; this is truly what has brought me back to the MJLH year after year. The breadth of talent that the students on this Board bring to the journal is inspiring, and it has really helped me grow both as a law student and as a person.  The challenge of bringing so many bright ideas to fruition over the course of the year, and being a part of the team responsible for fostering dialogue at so many Faculty events, is what makes this job so rewarding. As Executive Managing Editor, I now have more responsibility to ensure that our Board members’ ideas are fully developed so that we continue to enhance the visibility of health law issues on a large scale. I am really looking forward to overseeing our team’s ever growing success, but it would not be possible to do without the contributions of each and every member of the Management Board. Being a part of this team is by far the best part of my role.

What did you do this summer?

This past summer I worked full-time at Stikeman Elliott’s Montreal Office. It was a great opportunity to sharpen some of the basic skills that will be of use to me as a lawyer in the future.

Quelles sont vos ressources préférées pour les nouvelles de la santé?

The MJLH blog of course! It is always refreshing to be able to see what our Online Board members’ perspectives are on a variety of important issues. The posts are always very thought-provoking. I encourage you to check it out!

What attracted you to join the MJLH?

As a first year, the journal’s focus on health law was a big draw for me. I had a lot of experience in health policy as an undergraduate student, and I was curious to see how I could continue to pursue my interest in health issues as a law student.

Quels sont vos festivals d’été préférés de Montréal?

The Comedy Fest- hands down. I love catching one of their many themed shows. There is nothing better than spending an evening laughing.

MJLH Student Recruitment 2014-2015 / RDSM Recrutement d’étudiants 2014-2015

Posted By Katarina Daniels

The application forms for editorial, managerial, online and submissions and solicitations editor positions are now available online. The deadline for applications is September 17.

Should you have any questions about the journal or the application process, please do not hesitate to contact us at: editor.mjlh@mail.mcgill.ca or manager.mjlh@mail.mcgill.ca.

Jennifer Anderson, Editor-in-Chief, vol 9

Hersi Hujaleh, English Executive Editor

David Hamel, French Executive Editor

Samantha Allen, Executive Managing Editor

Katarina Daniels, Executive Online Editor


Les formulaires de candidatures pour les postes de rédaction, d’administration, de rédaction web, et de sollicitations et d’abonnements sont disponibles en ligne.

La date limite pour la soumission de candidatures est le 17 septembre.

Si vous avez des questions sur la RDSM ou sur le processus d’application, n’hésitez pas à nous contacter à: redacteur.rdsm@mail.mcgill.ca ou manager.mjlh@mail.mcgill.ca.

Jennifer Anderson, Rédactrice en chef, vol 9

Hersi Hujaleh, Rédactrice exécutive pour l’anglais

David Hamel, Rédacteur exécutif pour le français

Samantha Allen, Rédacteur exécutif administratif

Katarina Daniels, Rédactrice exécutive web