Birth & Midwifery in Canada
Resources for parents and practitioners

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Some of the following sites may not be in English; an online translator may be useful.

Birth Situation Room Report

Midwifery Today Country Contact*

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Louise McDonald has been practising midwifery in Canada since 1988 and has attended births in Alberta, Ontario, New Brunswick, Nova Scotia (her home base), Prince Edward Island, and Newfoundland and Labrador. She trained in 1986 with the Association of Ontario Midwives which pioneered the introduction of legislated midwifery in Canada. Louise is the mother of four homeborn sons and partner of a "long-suffering man who still wholeheartedly supports this difficult profession!" She is interested in sharing information about the challenges of "midwifing this northern nation into the 21st century."

Birth/Midwifery

Parenting/Breastfeeding

Education

What is the biggest challenge facing normal birth in your country and what is being done to address it? [September 2011]

We are a country of 10 provinces and 3 territories, spread out over 4000 miles from coast to coast. In 1993, after 10 years of political lobbying by parents and midwives, midwifery was finally proclaimed a regulated profession in the province of Ontario, which is our most populous province. British Columbia had legislated midwives working by 1998 and, in the following decade, most of the other provinces/territories followed suit. The East Coast provinces have been slower to pass legislation, lacking population, midwife practitioners and financial resources. However, Nova Scotia, the tiny province where I have practiced for over 20 years, finally passed its legislation in 2007.

From a couple of hundred midwives scattered across Canada in 1994, there are now almost 1000 midwives in practice, either working as employees of government health districts or as independent health contractors. There are also at least three different provinces offering a four-year Baccalaureate of Health Sciences in Midwifery, with several dozen new midwives graduating every year.

Midwives are mandated to offer women primary maternity care, choice of birthplace, informed choice options and as much continuity of care as individual practice constraints will allow. Midwife waiting lists are always full!

There is a downside to this rosy picture, unfortunately. Canada, like many industrialized countries, is now facing a severe shortage of maternity caregivers, with no easy way to replace older caregivers who are retiring or getting out of the demanding field of obstetrical care. Midwives are feeling the brunt of this shortage, with local governments asking that they curtail their time with women, take on heavier caseloads or even share call with family doctors or obstetricians.

There are other complex problems as well; for example, the necessity to acquire and maintain hospital privileges so midwives can attend their clients who are choosing to birth in hospital. Midwifery is still a young profession here, and most hospitals do not have a department of midwifery, so midwives’ practice falls under the jurisdiction of obstetrics. As a result, many midwives have their practice unofficially “supervised” by obstetricians. This arrangement narrows the freedom that midwives and clients have in their decision making.

While I have some serious concerns about the future direction of midwifery care in Canada, I cannot help but admire the tremendous hard work and dedication of so many parents and midwives who have literally recreated an ancient profession from the ground up, here in this beautiful country. For more information, please visit www.canadianmidwives.org.

— Louise McDonald
scotiamidwife@yahoo.com

Update on the Inuit of Northern Quebec [April 2009]

I am heading tomorrow to work in Puvirnituq for a month, an amazing community among the Inuit of Northern Quebec, where birth has been taken back by the community in spite of the full-scale evacuation of all women from there in the late ’70s and early ’80s by the Federal Medical Services Bureau. This community provides the hope of what a small community can do when the women take power and kick the white male dominant culture out on a snow drift.

Almost all of Northern Quebec has now been rematriated, and almost all birth now takes place back in the community again, with better outcomes, even though they are a two- to eight-hour plane ride to cesarean section facilities. This was the work of 20 years of Inuit determination and help from southern white midwives, while US communities seem to have gone the opposite direction in the same time period. While the Inuit hadn’t even heard of any “Yes, We Can” slogan, it was a case of cultural survival. That is what we need to transmit to women and communities at large. How birth is handled in any society is a barometer of that culture’s survival capacity.

Betty-Anne Daviss