GRSJ224/Midwifery

Defining Midwifery

Reproductive Health can be defined by the World Health Organization as “the reproductive processes, functions and system at all stages of life. Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.” .

Like any health-related field, many professionals are involved in insuring the health of the patient and midwives are no exception. The International Confederation of Midwives provides an inclusive definition of a Midwife and highlights that they are “recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period.” Included in this care comes the responsibility of providing education within the family and community in a variety of settings. This definition also states that a midwife’s role is to be aware of emergency measures, prevention of these measures and do their best to ensure a normal birth with no complications. According to 4th year student midwife Danielle McCreary of Mount Royal University “we are specialists in low risk pregnancies, which is most pregnancies and we also specialize in unmedicated delivery. The Canadian model is based on continuity of care.”

History of Midwifery in Canada

Prior to 1995 when the College of Midwives of British Columbia (CMBC) was established there was no regulatory system for midwifery as a practice. This meant it was not an accepted or welcomed integration into the provinces health care system. Two of the major goals of the acceptance of midwifery in Canada was for these health care professionals to be able to provide the highest standard of “safe, client-centered and evidence-based midwifery care."

The College of Midwives in British Columbia is a government body. The importance of developing CMBC was to create a governing body for midwives and a way to register midwives. Though CMBC was established earlier, for legal purposes, the term “midwife” was not used until 1998 in BC.

A recent development in midwifery in BC happened on Novemebr.27^th,2014. The Ministry of Health came into agreement with The Midwives Association of BC (MABC). The five-year contract helps foster the rise of midwifery with its aim to “sustain the midwifery profession, enhance midwifery services and increase access to maternity care throughout the province, especially in rural communities” . Provincial standards of midwifery vary slightly. The Canadian Midwifery Regulators Council provides links to each provinces regulators, education programs for aspiring midwives and associations of midwifery professionals here.

Midwifery has increased over time in Canada; however, midwifery is very rarely represented in the media as an option for birth. Though it may not always paint a perfectly accurate picture of reproduction, the media is often a source of general information about subjects that lack education and feel less common. Representation of midwifery in the media could provide a way to remind women of another choice they have when planning their families.

Midwife assisted births continually rises. According to the Midwives Association of British Columbia, in 1998 British Columbia housed 47 registered midwives. The province now proudly employs 324 registered midwives as of 2018.

Values of Midwifery

To fully appreciate midwifery as a practice, it is crucial to understand the core values midwives hold and the ways they strive to provide a unique, holistic and tailored birth experience for women in Canada.

1.    Autonomous Primary Care: Midwives take pride in providing the highest standard of care for mothers and their offspring starting early in pregnancy and continuously providing care until newborns are six weeks postpartum. Midwives in BC hold a position as the primary care provider for clients and are accessible without a medical referral. CMBC provides specific circumstances (documented here) about when care is to be transferred to another medical provider (ie. Obstetrician); however, midwives have vast capabilities and assume full responsibility for the most crucial aspects of childbirth. These standards speak to the careful regulation of this profession. Midwives are expected to follow these standards like any primary health care provider.

2.    Evidence-Informed Practice: similarity to any developing field, research is continually evolving. Midwives vow to stay informed on the most relevant maternal and newborn issues.

3.    Informed Choice: Midwives strive to provide relevant information allowing the opportunity for families to make decisions they feel supported in. The role of the midwife is not only to provide resources for clients but present them in an “objective…supportive and non-authoritarian manner."

4.    Continuity of Care: Midwives use a continuity of care model while caring for their clients. In order to successfully deliver the highest level of care and availability midwives work in teams. Teams usually consist of two to four midwives, this allows midwives to have time off but most importantly, team structured practice allows for the promise of continuity of care as a minimum of one midwife is on call 24-7 and continuously available to clients.

5.    Selection of Birth Setting: traditionally, in western culture it is assumed that births happen in hospital. This is an overgeneralization as in eastern cultures and now increasingly in the west, births are happening at home. Midwives are extended privileges to provide care at local hospitals if a birth becomes at risk and also offer mothers the decision to choose where they feel most comfortable bringing their children into the world.

6.    Independent Practice: midwives are government funded. Like physicians, midwives run their own practices and tend to lead around 80 births per year.

Professional Bodies

Legend: Black = International; Red = National; Green = Provincial

The online resources of information about midwifery are becoming more readily available to families as they navigate decisions about bringing children into the world. There are a number of professional bodies within Canada that are important to understand while considering using a midwife, becoming a midwife or simply understanding the practice of midwifery and its importance.

International Confederation of Midwives

The International Confederation of Midwives (ICM) is an organization that aims to advocate for midwifery as a practice at a global level. The ICM strives to promote midwifery as a way to "enhance the reproductive health of women."

Canadian Association of Midwives (CAM)

CAM is the Canadian headquarters for all things midwifery. This organization aims to support the practice of midwifery on a federal level.

Canadian Midwifery Regulators Council (CMRC)

The CMRC is the regulatory body for midwifery nationally and provincially. This councils goal is to provide the highest levels of standards and regulations to ensure the safe practice of midwifery throughout Canada.

National Aboriginal Council of Midwives (NACM)

The National Aboriginal Council of Midwives exists to support the highest standard of care for women from Inuit, Metis and First Nations backgrounds. NACM values the rights of indigenous people. This organization is very important in supporting a large marginalized, underserved population.

The Midwives Association of BC (MABC)

The goal of the MABC is to promote midwifery and women's reproductive health at a provincial level. Similarly, other Canadian provinces have their own associations that function at a provincial level to advocate for the highest standards of care.

Marginalized Populations

Canada has many populations that are underserved and may not always receive the highest standard of care due to lack of appropriate resources. Examples of these are: refugees, aboriginals and LGBTQ. The individualized care midwifery has to offer may be a way to reach these populations. In many eastern cultures, birth practices are uniquely diverse when compared to typical western views. For refugees, language may be a barrier, they may come with cultural specific health concerns and were brought up with different birthing practices. The continuity of care model midwifery offers is a great way to build relationships with these communities. Similarly in indigenous cultures. It would not be uncommon to see differing practices and having an autonomous primary care giver throughout your pregnancy is a way to help establish respect for culture and trust. Traditional health care systems, due to limited resources may not be able to provide the same individualized care that a midwife can offer.

The Canadian Association of Midwives also advocates for gender inclusivity by stating "We are working to ensure that trans, genderqueer, and intersex people in our care and in our communities are not denied or made invisible and we believe that this does not undermine our ability to provide woman-centered care." This speaks to the vision of midwifery being inclusive despite diversity.