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.

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