Midwifery in Atlantic Canada:
We want it, we need it, we deserve it
Marlo Shinyei
Midwifery: The Basics
Midwives are health care professionals who provide care to women throughout pregnancy and birth, and for six weeks after the birth, including care for the newborn.
Midwives provide comprehensive clinical care. As primary caregivers, midwives take sole responsibility for care in the same way that a family physician would; a woman in midwifery care does not need to see a doctor unless she or her midwife has a specific concern. Midwives meet with their patients regularly, beginning in early pregnancy. Visits usually last between thirty minutes and one hour, allowing the midwife to assess the health of both the woman and her baby and leaving plenty of time to answer questions, address any concerns or fears about tests or procedures, and help prepare for the upcoming birth. On call twenty-four hours a day, midwives provide continuous support throughout labour and help deliver the baby, whether their patients give birth in a hospital, at home, or in a birth centre. Immediately after the birth, midwives assess the physical health of a woman and her baby, and provide all of the necessary care, including breastfeeding support. In the days following the birth, midwives visit women at home or in the hospital, assessing their physical health and providing support when needed. For the baby’s first six weeks, midwives are available by phone and will make a few more visits to ensure that a woman and her family are off to a good start.
Midwifery in Canada
In British Columbia, Alberta, Manitoba, Ontario, Québec, and in the Northwest Territories, midwifery is legislated and, with the exception of Alberta, the service is publicly funded.
Midwifery supporters in New Brunswick, Prince Edward Island, and Newfoundland and Labrador are hopeful that their provinces will soon follow the Government of Nova Scotia’s lead by taking the first steps toward regulating the profession of midwifery. Much work is yet to be done before midwives will be fully funded and integrated, but how will this decision affect maternity care in Atlantic Canada?
To answer this question, we can look at British Columbia, Alberta, Manitoba, Ontario, Québec, and the Northwest Territories where midwifery is regulated. These provinces/territories have integrated midwives into the healthcare system as autonomous primary care providers. Midwives collaborate with nurses, physicians, and other health-care professionals in the provision of high-quality maternity care. Regulated midwifery in Atlantic Canada would likely be based on these existing
models which have achieved excellent health outcomes
for mothers and babies and include high standards for midwifery education.
The Midwifery Model of Care
The Canadian Association of Midwives believes in a primary care model of midwifery that is community-based, collaborative, and founded on the principles of:
- Woman-centred care
- Informed Choice
- Continuity of Care Provider
The Evidence for Midwifery
The largest study of home births attended by certified professional midwives in North America found that there were far fewer interventions in planned home births than similar births for low risk patients in hospitals, with similar intrapartum and neonatal mortality.1 Comparable results were found in a study that followed the regulation of midwifery in British Columbia.2
Ontario’s Ministry of Health recently completed an evaluation of its midwifery program and similarly found a significantly reduced rate of interventions among midwifery clients, accompanied by rates of fetal and infant mortality that were comparable to the province’s overall rates.3
Midwifery Education
The education standard for regulated midwives in Canada is a four-year university degree, currently offered by McMaster, Laurentian, and Ryerson Universities in Ontario, Université du Québec à Trois-Rivières, the University of British Columbia, and the University College of the North in Manitoba. Provincial/territorial Colleges of Midwives offer a prior learning and experience assessment (PLEA) to midwives who are foreign-trained, or who have a combination of apprenticeship training along with self-directed study or a background in obstetrical nursing. Midwives who successfully complete the PLEA may be registered to practice. A number of regions across the country also recognize traditional Aboriginal midwifery education.
Midwifery’s Role in Primary Care
The goals of primary health care renewal are to improve access to care, to emphasize health promotion; to establish multi-disciplinary teams; and to improve health outcomes. As a client-centred and community based model, midwifery is poised to fill the gaps.
Improving access to care
The maternity care crisis in Canada is evident. Less than 20% of family physicians are attending births. Hospitals are closing in rural
communities across Atlantic Canada, leaving many women to travel long distances for prenatal care and to give birth. Even in large urban centres, some women may not be able to access the type of care they need.
Midwifery is ideally suited to improve access to maternity care. In the provinces/territories where it is regulated, midwifery is the only maternity care profession that is growing. Midwives are providing care in small, community-based practices. They are on call for their clients twenty-four hours a day, seven days a week, and often make home visits.
Emphasizing health promotion
Health care is about more than treating illness. Midwives view pregnancy as a healthy state and birth as a natural process. They take a holistic approach, considering the physical demands of childbearing while acknowledging the individual differences between women’s spiritual, social, and cultural needs. The midwifery approach provides individualized care that promotes the health of all women and can help to address the needs of marginalized populations, reducing health inequities and fostering social inclusion.
Establishing multi-disciplinary collaboration
The Health Council of Canada asserts that “the successful reform of primary health care will make better use of highly qualified health professionals.” In countries like New Zealand, where over 70% of births are attended by midwives, the specialized skills of obstetricians are used efficiently when complications or emergencies arise. In contrast, obstetricians attend over eighty per cent of births in Canada, most of which are uncomplicated, representing an inefficient use of high-level skills and training.
In the provinces and territories where midwifery is regulated, midwives collaborate with physicians and other health care professionals to provide the most appropriate care. Midwives are exclusively trained to care for low-risk women during pregnancy, birth, and the postpartum period. Including midwives on multi-disciplinary teams contributes to the effective management of health human resources. It ensures that the most appropriate care is provided by the most appropriate care provider.
Improving health outcomes
Ontario’s Ministry of Health recently completed an evaluation of its midwifery programme and found the following results:
|
With midwifery care |
With physician care |
Improved breastfeeding rates (at 6 weeks) |
90.7% |
71.5% |
Reduced caesarean rates |
12.7% |
20.6% |
Fewer operative vaginal deliveries |
5.4% |
14.4% |
Fewer episiotomies |
7.2% |
16.6% |
Early hospital discharge (<24 hours) |
74.2% |
2.36% |
Bringing Birth Back to the Community: A Midwifery Success Story
Traditional Aboriginal midwifery recognizes that birth is a deeply spiritual, social, and cultural event. This view explains the sense of loss felt by many Aboriginal communities in the early 1970s when it became a common practice to evacuate women to give birth in urban centres thousands of miles from home.
Aboriginal communities have long felt the need for improved access to culturally appropriate health services, and there is an established priority to increase the numbers of First Nations, Inuit and Métis health professionals. The profession of midwifery is leading by example with initiatives such as The Inuulitsivik Maternity Centre in Québec, the Six Nations Maternal and Child Centre in Ontario, and a birthing centre at Rankin Inlet in Nunavut. At these centres, Aboriginal and non-Aboriginal midwives collaborate with other health professionals to provide a full range of health services to pregnant women. Women are no longer forced to travel to urban centres to give birth. They stay in their home communities surrounded by family, and their care responds to their physical, spiritual, and cultural needs.
Education programs also exist at some of the centres to ensure the sustainability of Aboriginal midwifery. Most recently, the University College of the North in Manitoba accepted the first of class of students into the Aboriginal Midwifery Education Program – a 4-year degree program founded in Aboriginal teachings and culture and blended with western methods of clinical practice.
By bringing the necessary knowledge of and respect for culture and history to their work, Aboriginal midwives across Canada are bringing birth back to their communities.
Why Do Atlantic Canadians Need Midwifery?
(Adapted from Ten Reasons Why We Need Midwifery in Nova Scotia, Midwifery Coalition of Nova Scotia)
Midwives are experts. In Canada, midwives are the only health care professionals trained exclusively for the care of childbearing women.
Midwives promote the health of women and babies. Women who receive the extra support provided by midwives are less likely to have caesarean sections or other interventions, and are more likely to breastfeed.
Midwifery is family-centred. Midwives work together with women and their families, building a relationship based on respect for each woman’s health, social and personal needs.
Midwifery is safe. The safest way to give birth is with a trained and skilled attendant. Doctors and midwives are both trained to deliver babies and the research shows that both options are equally safe.
Midwives offer personalized care. Midwives provide continuous support throughout pregnancy, birth, and for six weeks after the birth. Women feel reassured that someone who knows them well will attend their birth, and will be available for support and advice after the baby arrives.
Midwives are flexible and accessible. Midwives are trained to attend births in hospitals, in birth centres, or at home. They are on call 24 hours a day, seven days a week, and often make home visits!
Midwives respect diversity. Midwives provided individualized care in small, community-based practices. This model is ideal for providing appropriate care for women from diverse communities.
Midwives are part of the health care team. Midwives work together with nurses, doctors, and other health professionals to provide women with the highest standard of care.
Midwifery care is a choice more families are making. Midwifery is becoming a popular choice for families in provinces where it is regulated and funded. Each year in Ontario, more than 10,000 babies are born with the help of midwives!
Atlantic Canadians deserve it! In British Columbia, Alberta, Manitoba, Ontario, Québec, and in the Northwest Territories, midwifery is legislated and, with the exception of Alberta, the service is publicly funded. Atlantic Canadians deserve to have the same maternity care options as other Canadians.
This article is adapted from “Want to know more about midwives?” written by Marlo Shinyei and published by the Atlantic Centre of Excellence for Women’s Health. Photo Credit for "Bellies": Lea Safranovich.
For more information:
Canadian Association of Midwives
Multidisciplinary Collaborative Primary Maternity Care Project
New Brunswick Birth Matters
Newfoundland & Labrador Friends of Midwifery
Nova Scotia Midwifery Coalition of Nova Scotia (MCNS)
Prince Edward Island Birthing Options Research Network (BORN)
References:
1. Johnson, K. C., & Daviss, B. A. (2005). Outcomes of planned home births with certified
professional midiwives: Large prospective study in North America. BMJ, 330(7505),
1416-1423.
2. Janssen, P. A. et al. (2002). Outcomes of planned home births versus planned hospital
births after regulation of midwifery in British Columbia. CMAJ, 166(3), 315-323.
3. Ministry of Health and Long-Term Care. (2004). Ontario Midwifery Program Evaluation:
Presentation to the Association of Ontario Midwives Conference. Toronto: Author.
