Midwives play integral role in the health-care system


Before midwives were regulated in Ontario, they practiced without hospital privileges. But not anymore. Today, over 60 midwifery clinics provide care to women and newborns across the province. In addition to working in their own clinics, midwives provide care in the community and in 75 Ontario hospitals.

“At the hospital where I have privileges, midwives are respected as professional colleagues,” says Katrina Kilroy, Association of Ontario Midwives (AOM) President and a midwife with privileges at Mt. Sinai hospital in Toronto. “Fifteen years ago it was an adjustment when we started working as primary care providers in hospitals, and it remains a challenge in some hospitals around the province. Having midwives working to their full scope in hospitals allows us to retain primary care for normal, low-risk labour and birth.”

Kathryn Hayward-Murray, nursing director at The Credit Valley Hospital points out: “Obstetrical medical care can be provided by  a variety of health practitioners. It is important to ensure the right provider is matched to the patient’s needs. Midwives can play a very valuable role in meeting the needs of families who are experiencing a normal pregnancy and expecting a normal birth.”

From Kenora in the north to Leamington in the south, midwives are an important part of providing primary care to pregnant women and newborns all across Ontario, in rural and remote areas as well as cities.

In 1994 midwifery became a regulated profession like nursing and medicine. Since then, midwives have attended more than 85,000 births in Ontario hospitals and homes – 20,000 of those were home births. “With my midwives, I had the births I wanted,” says Sarah Latha-Elliott, mother of four-year-old Sumayya and one-year-old Yaaseen. “My babies and I all received excellent medical care delivered by caring and respectful midwives.” Currently, midwives attend about 11,000 births a year. That’s approximately 8 per cent of Ontario births and numbers are growing. In fact, the number of midwives is projected to double from about 400 to 800 in just four years.

“People made a lot of assumptions when they found out that I had a midwife,” says Latha-Elliott. “They assumed that I would not be able to give birth in a hospital, that I would not have access to pain relief and that my care would be som ehow primitive. But that was not the case. My midwives provided me with sophisticated, personal care. They provided research-based information about my options. I was never limited because I was a midwifery client. Midwives are part of the health-care system and I had access to tests, ultrasounds, and hospitals as needed. You name it. It was excellent care.”

However, despite midwifery’s success, the need for public education about midwives still exists.

“We’re always trying to let women know they have a choice,” says Kilroy. The AOM has launched a provincial public education campaign to challenge some commonly held myths about midwifery care. “We want all women and families to know that midwifery care is safe at home or in the hospital, clients do not pay and outcomes are excellent,” she says.

In order to practice in Ontario, midwives complete a four-year university degree at McMaster, Ryerson or Laurentian. Internationally trained midwives access a bridging program offered through Ryerson University. Numerous rigorous government and academic studies have demonstrated that midwifery care is safe, including a recent study based out of Montreal. The Cochrane study, which looked at the experience of 12, 276 women, concluded that all women should be offered the option of midwifery care.

Women who live in Ontario have access to free midwifery care. Like nurses and doctors, midwives are paid by the Ministry of Health. Individual women do not have to pay for care.

Women are cared for by a small team of midwives. So clients are likely to know the midwife who delivers their baby. Women and their families are able to develop a relationship with their midwives at regular, lengthy appointments. Partners and children are welcome to attend and participate at appointments.

With a midwife, women can choose to have their baby in the hospital or at home. Midwives provide information and support to help mothers breastfeed. Whether the birth was at home or in the hospital, midwives visit women in their own homes in the first few days after the baby is born to monitor the health of the newborn and of the mother and to provide dedicated support to infant feeding and care. Midwives care for women throughout pregnancy, birth and for six weeks after the baby is born.

Experts in normal birth, midwives are trained to detect situations that may require care from a physician. When needed, midwives collaborate with physician and nursing colleagues as indicated. If a woman or newborn needs specialized medical care, their care is transferred to the appropriate provider, typically an obstetrician or a paediatrician.

“One of the reasons I chose a midwife is because I knew she would support me in making informed decisions and in having a birth where I felt in control,” says Latha-Elliott. “I want other women to have this choice too. I can’t imagine a better way to start my children’s lives or my journey as a parent. My midwives recognized my pregnancies and births as profound events in my life too.”

The AOM has launched a campaign to let women know that midwives provide safe, free, and excellent care. Anyone can participate in the campaign by asking local hospitals, doctors’ offices or community health centres to display the campaign posters and other materials.

To find a midwife in your community visit www.aom.on.ca or www.canadianmidwives.org/