In 1892 Dr Wilfred Grenfell arrived in Newfoundland. He established hospitals in Labrador and on the Great Northern Peninsula of Newfoundland which were staffed by British nurses who were often midwives. Even today, there is a special agreement between the Department of Health, the Newfoundland Medical Board (now the College of Physicians and Surgeons of Newfoundland and Labrador), and the Association of Registered Nurses of Newfoundland that enables registered nurses who have midwifery qualifications from another jurisdiction, and are employed by the Labrador Grenfell Health Board, to practise a limited scope of midwifery. In 1920 midwifery legislation was passed in Newfoundland. The Government appointed a board to examine and provide licenses to practise to midwives. Lady Harris, the wife of the Governor, immediately went to Britain to recruit nurses who were midwives and health visitors (public health nurses) to come and work in Newfoundland outports. The outports were responsible for providing accommodation and paying the nurse's salary. In 1924 the Newfoundland Outport Nursing and Industrial Association (NONIA) was established to assist the communities in being able to pay the nurses by the selling of crafts. NONIA also bought the medical supplies which the nurses needed. In 1934 the reorganization of health care resulted in cottage hospitals being built, where women were expected to go for the birth of their babies. NONIA was no longer responsible for nursing in the outports, but the Department of Health was responsible for both midwifery and nursing. The 18 month midwifery and paediatric programme which had been provided by the Salvation Army Grace Maternity Hospital in St. John's from 1924 was discontinued in 1934. Midwives who were not nurses had been able to enter this programme, although once the Nursing School commenced in 1929 many midwives who graduated from this programme decided to become nurses. The Department of Health was now responsible for training midwives who were not nurses. These women who were in their 30s were brought to St. John's to attend a 2 month course at the Salvation Army Grace General Hospital. After their training they were provided with the basic essentials for a birth, for both the mother and baby. When they had used the supply of solutions or silver nitrate they could requisition a further supply. Most Outports chose a well respected woman to be a midwife. When this midwife was getting older an apprentice was chosen by the community to assist the midwife and learn about midwifery. The midwife was often paid in kind according to what the family could afford. When midwives received an education they moved to a community to practise, which was usually not from where they originated. The educated midwives expected payment in money, and McNaughton (1989) called them entrepreneur midwives. In 1949 Newfoundland and Labrador became a Canadian province. In 1958 the Hospital Insurance Act came into effect and women no longer had to pay $15 to be attended during childbirth; care in hospitals was now free. In 1961 and 1962 there were no applications for new licenses, and in 1963 there was only one application. Therefore, the Provincial Government considered that midwives were no longer required and ceased to appoint a Board to issue the annual licenses to midwives practising in the province. Bill 56 to repeal "An Act Respecting the Practice of Midwifery" was passed by the Government of Newfoundland and Labrador in December 2008. In 1979 the first class of nurses was admitted to a midwifery programme at the School of Nursing, Memorial University of Newfoundland. Midwifery was also part of the University's Outpost Nursing diploma programme. The last class to graduate was in 1986 as financial restraints have prevented it from being offered again In 1992 the obstetrical unit at St. Clare's Mercy Hospital was combined with the obstetrical unit at the S.A. Grace General Hospital. In 2000 the S.A. Grace General Hospital was closed and the obstetrical unit moved to the Health Sciences Centre/Janeway Hospital, a tertiary care setting. This is the only hospital in the eastern part of the Avalon Peninsula where a woman may give birth to a baby. Some women do make private arrangements to have a home birth attended by an out-of-province midwife who they fly in for the occasion. A midwife who lived in the area attended home births for a while but in 2010 moved away for family reasons. In 1993 the Provincial Government appointed an Advisory Committee on Midwifery and they recommended that an implementation committee should be appointed. The final report was presented in May 1994. To request a copy of the Final Report of the Advisory Committee on Midwifery contact the Minister of Health, Government of Newfoundland and Labrador, P.O. Box 8700, St. John's, NF A1B 4J6. In the Autumn of 1999 the Provincial Government appointed a multi-disciplinary Midwifery Implementation Committee with Brenda FitzGerald (social worker), Executive Director of Health and Community Services St. John's Region, as the chairperson. After Ms. FitzGerald transferred to another position, Karen McGrath (social worker) was appointed as chairperson. The first meeting was held on October 20, 1999. The main task of the Midwifery Implementation Committee was to provide advice on the development of legislation related to midwifery and the implementation of midwifery services in Newfoundland and Labrador. The Committee was also responsible for providing recommendations related to the scope and standards of midwifery practice, midwifery education and registration requirements, and eventually the establishment of a Board (College). For this purpose subcommittees were formed to study these items and what was needed to communicate to professionals and the public about midwifery in the 21st century. The Midwifery Implementation Committee completed it's mandate and the final meeting was held on October 22, 2001. The government then decided to shelve the idea of midwifery legislation. A Final Report of this Committee was never made available to committee members. On December 8, 2008 when there was the second reading of Bill 56 to repeal the old Midwifery Act the Minister spoke at length about modern day midwifery being "an autonomous profession practicing with a set of guidelines that will define their scope of practice and define through regulation how they will be a part of a health care team." He then said, "I have given an undertaking in this House, as a minister, to engage my staff in our department to develop the necessary legislation and the policy framework that will allow us to come back into this House next year and we will introduce a bill. . . . We will be introducing some ground breaking legislation for this Province as we introduce a new umbrella piece of legislation dealing with a variety of health disciplines of which will be the practice of midwifery. We look forward to working with the provincial association in consultation as we develop this particular piece of legislation." In November 2009 a letter was received with an invitation to participate in consultations concerning the umbrella legislation. "The Department of Health and Community Services has been researching legislative models for 'umbrella legislation' to govern a number of health professions that may require regulation. Our goal is to construct a statute that governs a number of health professions as opposed to stand-alone statutes for individual professions." Four members of AMNL and the coordinator of Friends of Midwifery attended a meeting at the Confederation Building for a presentation explaining the "Umbrella Legislation Discussion Paper" that listed 14 unregulated professions, although midwifery is the only listed profession not currently practicing in the province. Response to this paper and to another questionnaire regarding "Occupation Seeking Regulatory Status" were submitted in the middle of December. Nothing further was heard regarding this proposed legislation until May 4, 2010 when the representatives of the various professions who attended the consultation meetings were invited to a late afternoon meeting being held the following day. At this meeting the attendees were advised that "Bill 17. An Act Respecting the Regulation of Certain Health Professions" was being introduced into the House of Assembly the following afternoon. In June 2010 Bill 17 had second and third readings and received assent. Now the listed professions have to develop regulations, who will compose their respective Colleges and decide on two of their members to sit on the Council. There will be one registrar for all professions who will be on the Council, but not as a member. When one or two professions are ready the legislation will come into effect. Bill 17 In August 2011 Pearl Herbert and Kay Matthews, midwives, received a letter from the Minister of Health and Community Services advising that he was "pleased to affirm your appointment as a Member of the Newfoundland and Labrador Council of Health Professionals in accordance with sections 8 and 9 of the Health Professions Act. Your appointment will take effect from July 25, 2011 and will expire on July 25, 2012." (This date has now been extended to 2014) A meeting of the Council was called for September 27. The Council consists of 6 members of the public and two representatives for each of the six health professions (as two of the seven listed in the Schedule of the Act have amalgamated). The first work of the Council was to develop By-Laws for the Council, and appoint a Registrar, which costs money. The Minister has said that there is no funding. This is in addition to setting up the professional Colleges. None of the professions have yet received the regulations that the Government is developing for their particular profession. The Council of Health Professionals is responsible for regulating and registering the members of the listed professions. Web Site NLCHP Midwifery in this province does not have a niche in the health care system. The documents prepared for the MIC (1999-2001) have been updated where necessary. The main outstanding issues include funding, especially for the initial registration process for midwives and employment in order for midwives to have liability insurance with HIROC, which provides coverage for the majority of midwives in Canada. It is crucial the midwifery is publicly funded the same as in the 8 provinces and 2 territories where midwifery is regulated. Also to be decided is how midwives from jurisdictions outside of Canada will initially be registered. Midwives registered in Canada are covered by AIT Labour Mobility. Midwives are midwives, practice autonomously and do not require any further qualifications. It is important that midwives who may be interested in practicing in the province once midwifery is regulated contact AMNL, through the mail box on the home page, so that they are kept informed of not only the regulation progress but also how midwives are initially going to be registered. The Government of NL is asking for possible numbers of midwives who will be registered so we need to know midwives registered outside of Canada as well as in other Canadian jurisdictions who may be coming to practice in Newfoundland and Labrador. We hope that in the not too far distant future midwives will be able to provide woman and family centred care that meets individual needs, that promotes the healthy, normal process of pregnancy and birth, to mother and baby until 6 weeks after the birth, for all those in Newfoundland and Labrador who desire midwifery care. The annual national CAM conference was held in St. John's in October 2012. At that time the Minister of Health and Community Services said that they were "studying how best to integrate midwifery into the health care system. Regulation for all professions under our Health Professions Act is a priority for our government". It is understood that the government is planning a contract with McMaster University for two midwives to advise regarding regulations and implementing midwifery in Newfoundland and Labrador. Karyn Kaufman, retired Dean of the midwifery program at McMaster University, and Helen McDonald, practicing midwife and instructor at McMaster University were contracted by the provincial government to advise on the implementation of midwifery in the province. They visited the province May 8 to May 15, 2013 to interview stakeholders. AMNL members had a meeting with the two consultants on May 11. The government has requested the report for Fall 2013. The provincial government received the report at the end of December 2013. The Minister of Health and Community Services released the report "Implementing Midwifery in Newfoundland and Labrador" on February 27, 2014, at the Women's Health Clinic, Health Sciences Centre during a breastfeeding clinic. In Appendix D of the report is a time line, which shows that the first registered midwives could be practicing in 2016. An Advisory Committee is recommended. Midwives in the province will need to demonstrate that they have the knowledge and skills comparable to midwives in other regulated jurisdictions in Canada. A College of Midwives of Newfoundland and Labrador will advise the Council of Health Professionals of the requirements for midwives to be registered. The Council then takes this advice when making decisions about registering individual midwives. Implementing Midwifery in Newfoundland and Labrador On November 25-26, 2014 the Midwifery Regulations and Policy Advisory Committee (RPAC) appointed by the provincial government, had their first meeting chaired by Heather Hanrahan of the Department of Health and Community Services. This was a face-to-face meeting of registered midwives from Ontario, Manitoba and Alberta, government lawyers, the Registrar of the NL Council of Health Professionals, the President of the AMNL, and Pearl Herbert an AMNL member and a member of the Council of Health Professionals. The new government appointed Midwifery Implementation Committee (MIC) composed of representatives from the four Regional Health Authorities, representatives from the Provincial Perinatal Program, and provincial government personnel, and the AMNL President, also met at this time. Since then the MIC has met monthly. Currently they are meeting by conference calls with representatives from other jurisdictions to find out how the midwifery model in their area functions. Members of the AMNL have been invited to these meetings. The RPAC met by conference call on April 1, 2015 to answer questions that the lawyer had about the content of Regulations. The Regulations are nearly completed and on June 4 there is a meeting to discuss the College of Midwives of NL that is needed as soon as the Regulations come into effect. The College is composed of registered midwives and at present there are no Canadian registered midwives in the province. The following are examples of where more information regarding the history of midwifery in Newfoundland and Labrador may be obtained: Benoit, C. (1991). "Midwives in passage". St. John's: ISER, Memorial University of Newfoundland. Harvey, Larry. "Midwife in Carmanville - Aunt Nora Ellsworth. Maritime History Archives (104-C-02-18). Memorial University of Newfoundland. Kiss, Scott. "Midwifery in Tilting Fogo Island. Maritime History Archives (Nemec 0939). Memorial University of Newfoundland. McNaughton, J. (1989). "The role of the Newfoundland midwife in traditional health care 1900-1970". Unpublished doctoral dissertation. Memorial University of Newfoundland. Nevitt, J. (1978). "White caps and black bands". St. John's, Jesperson. "Report of the Northern Childbirth Workshop". (Held at Makkovik, Labrador, January 30 to February 1, 1990). North West River: Labrador Inuit Health Commission. Other materials which have been researched in this province: Beaudry, R. (1997). "Women's lived experience with midwifery support: A phenomenological study". Unpublished masters thesis. Memorial University of Newfoundland. Corkum, D. (1998). "Breastfeeding: Attitudes, perceptions and practices in Labrador". Goose Bay: Local Public Health Information Development, Melville Hospital. (Includes the midwives located at Melville Hospital). Dwyer, A. (2005, April). A mother's choice. "Downhomer", pages 44-49. Okalakatiget. "Prenatal awareness" video. Available from the producer, P.O. Box 160, Nain, Labrador, A0P 1L0 (Fax: 709-922-2293) O'Leary, S. (1998). "Motions". A celebration of lifecycles video. Available from the producer, P.O. Box 1132, St. John's, NF, A1C 5M5 (Telephone: 709-722-4662) Plummer, K. J. (1999). "Government-sanctioned midwifery in Canada, 1919-1991". Unpublished master's thesis. Yale University School of Nursing (contains much information about Newfoundland and Labrador). Plummer, K. J. (2000). From nursing outposts to contemporary midwifery in 20th century Canada. "Journal of Midwifery & Women's Health", 45(2), 169-175. Slaney Brown, E. (2007). "Labours of love.[Traditional] Midwives of Newfoundland and Labrador". St. John's: DRC Publishing.