Current Midwifery Situation in Canada
Although midwives have been practising in Canada ever since
people first lived here it is only recently that there has been a
move to require legislation. Legislation ensures that midwives are
qualified to practice (see the International Definition of a
Midwife). The methods of passing legislation vary from province to
province. First legislation is passed and then when all the
criteria (policies, standards of practice, education requirements
etc.) are complete a date is set for implementation. Once
legislation comes into effect the term "midwife" is a protected
title and only those who are licensed may use it. A person without
a license who calls themselves a "midwife" can be sued.
Midwifery legislation was first considered or introduced in:
1991 in Ontario and implemented on January 1, 1994.
1992 in Alberta and the Midwifery Register for licensure
was opened in July 1998. In September 2008 the provincial
Government announced that midwifery would be funded.
1993 in British Columbia, implemented January 1, 1998
1994 in Manitoba. In June 1997 Bill 7, the Midwifery and
Consequential Amendments Act was passed. In December 1998
the MIC received permission to register midwives for practice.
In March 1999 the MIC became the Transitional Council of
the College of Midwives. Midwifery legislation came into effect
on June 12, 2000. Midwives are employed by the Regional Health
Authorities.
1997 in Saskatchewan, May 5, 1999, third reading of Bill 44,
Midwives Act, and it was given the Royal Assent. It was revised in
2007 and came into effect on March 10, 2008.
1996 The Nova Scotia government commissioned the Reproductive Care
Programme (RCP) to study various aspects of midwifery. In 1997 the RCP
released their report. In 1998 the Health Minister appointed an
Interdisciplinary Working Group (IWG) on Midwifery Regulation. The IWG
submitted their report on June 2, 1999, and on June 25 the Health Minister
announced that a start was being made in drafting legislation over the
summer months for regulating midwifery in Nova Scotia. But, there was a change
in the provincial government and plans for legislation were put on hold.
However, in November 2006 "Bill No. 107. An Act Respecting Midwifery" was
introduced and on November 23, 2006 it passed the third reading and was
given the Royal Assent. In March 2008 the Nova Scotia government announced
that a regulatory council would be created with statutory authority to
establish requirements for professional designation as well as to endorse
standards of practice and competence. The Act was proclaimed and came into
effect on March 18, 2009. Licensed midwives may work in private practice
or be funded to practice in an arrangement with health care agencies or other
providers. Initially, through the establishment of model sites, provincially
funded midwives will work within integrated primary maternity care
teams in a limited number of settings representing population and geographic
diversity.
Midwifery
1990 in Quebec - Bill 4 was passed to allow midwives assessed
as being qualified, but not licensed, to practise at recognized
sites for a limited time. That project has now ended, and has been
evaluated. In December 1997 the final report of the "Conseil
d'Evaluation des Projects-Pilots Sages-Femmes" was released and the
majority of the recommendations were accepted by the Quebec
Ministry of Health. The law for the pilot projects was extended
until midwifery legislation was passed and implemented.
The new law, Bill 28, for midwifery legislation, was adopted by the
National Assembly on June 17, 1999, and came into effect on
September 24, 1999. At this time "midwife" became a protected title.
For information about midwifery legislation see government publications,
click on "lois et reglements", then enter "midwives" in the search box,
set the circles for "projects de loi" and "recherche simple", then click
on "demarrer la recherche". When the title of the act appears, click on
the title and save it on disk. When it is saved it can be opened from the
disk. For the french version follow these guidelines but put
"sages-femmes" in the box.
Midwives Act, June 1999
For Quebec Midwives Acts in English search for S-0.1_A Midwives Act, and
S-0.1, r.2_A Regulation respecting the standards and conditions of
practice for conducting home deliveries.
Midwives Act in English
Since October 1986 Nunavik's Inuulitsivik midwifery service has been
providing complete perinatal services in Inuktituk to the communities of
the Hudson Bay region. Three maternity centres serve seven villages. In
2008 the northern midwifery program was assessed and midwives who graduate
from this program can apply for full licensure with the Order de Sages
Femmes du Quebec. This recognizes and values traditional pathways to
learning midwifery.
1996 in the Northwest Territories the government agreed to
policies regarding the practice of midwifery in that territory. The
pilot project at Rankin Inlet (now in Nunavut)was evaluated as being
satisfactory.
In 1999 Nunavut was born. Midwifery legislation was drafted and in
2007 passed two readings in the House, and in 2008 passed the third
reading of Bill 20 The Midwifery Profession Act, and Royal Assent was
given. The Midwifery Profession Act came into effect on July 30, 2009.
In May 2003 the Northwest Territory government contracted a
consultant team to evaluate the documents prepared for midwifery
legislation. The Midwifery Profession Act was passed in October 2003
and came into effect in 2005 and there have been some revisions.
In April 2008 the New Brunswick government announced that it will
introduce legislation to regulate and allow midwives to practice. By 2009
the plan is to have eight midwives practicing in the province as
employees of the Regional Health Authorities, and then to add four midwives
per year according to the needs in the regions (but no date has been
given). On June 18, 2008 the Midwifery Act, Bill 11.5 received Royal assent.
Provincial Health
Plan On August 12, 2010 the Midwifery Act was proclaimed. Midwifery Act
In 2013, due to some financial restraints, the New Brunswick government
placed on hold the work of the committee working on the necessary
documents for midwives to be able to become registered.
1999 in the Yukon Territory permission was sought to enable
midwifery legislation to be developed. A birthing centre was being
established but was unable to proceed because of insurance problems.
Currently, May 2010, the Yukon government is considering regulating
midwifery in a Health Professions Act. Nearly two years later and no
movement.
In Prince Edward Island midwifery legislation has not been initiated
but in 2007 the political parties expressed an interest in midwifery. In
2013 midwifery legislation was being considered, but the midwives were not
satisfied with the direction that this was heading and requested that the
process be halted.
In December 2008 the Newfoundland and Labrador government said
that it was proceeding with developing an umbrella act which would
include midwifery. (See the history of midwifery in Newfoundland and
Labrador for more information about the Health Professions Act 2010.)
Where legislation has been passed it is for autonomous
midwifery - the midwives are not required to have additional
qualifications, such as nursing. Once legislation comes into effect
midwifery care for women and newborn babies in all provinces/
territories is covered by the provincial/territorial health care plan.
Midwives provide safe care, which is cost efficient and enhances
women's overall satisfaction with care throughout pregnancy, birth and
postpartum:
Allen, V. M., et al. (2005). Economic implications of method of
delivery [in Nova Scotia.] "American Journal of Obstetrics and
Gynecology", 193(1), 192-197.
Cameron, H. L. (2005, May). Modern midwifery in Ontario: An
effective model of health care. "University of Toronto Medical Journal",
82(3), 207-209.
Canadian Institute of Health Information. (2006). Giving birth in
Canada: The costs.
http://secure.cihi.ca/cihiweb/products/costs_report_06_eng.pdf
Canadian Institute of Health Information. (2007, July 25). Giving
birth in Canada: Regional trends from 2001-2002 to 2005-2006.
http://secure.cihi.ca/cihiweb/en/downloads/childbirth_aib_final_E.pdf
Janssen et al. (2012). Home birth: Costs of planned home vs hospital
birth in BC attended by registered midwives and physicians.
http://www.cjmrp.com/conference2012/Friday-Janssen.pdf
MacDorman, M. F., & Singh, G. K. (1998). Midwifery care,
social and medical risk factors and birth outcomes in the USA.
"Journal of Epidemiology and Community Health", 52(5), 310-317.
Schroeder et al. (2012). Cost effectiveness of alternative planned
places of birth in woman at low risk of complications: Evidence from the
Birthplace in England national prospective cohort study.
http://www.bmj.com/content/344/bmj.e2292
Turnbull et al. (1996). Randomised, controlled trial of
efficacy of midwife-managed care. "Lancet", 148, 213-218.
In Ontario, where midwifery is regulated, for the 3740 women
attended by midwives in 1996:
there were fewer episiotomies, 8% compared with 50% of
physician attended births;
5% of women used epidural anaesthesia for pain relief
compared with 30% of physician attended births;
95% of the mothers were successfully breastfeeding at 6 weeks;
40% of midwife-assisted births took place at home representing
the lowest cost option for healthy births
(Association of Ontario Midwives. (1997). "Fact Sheet. Cost
Effectiveness of Midwifery Care").
http://www.aom.on.ca/Communications/Government_Relations/Benefits_of_Midwifery.aspx
In Quebec where midwifery is regulated, in 1997 there was
a saving of approximately $780 per mother who received
pregnancy, labour and birth, and postpartum care from midwives,
when compared with the cost of similar care received from
physicians at hospitals.
(Evaluation des projets-pilotes de la pratique des sages-
femmes au Quebec. Rapportfinal. 1997).
"The reduction of interventions, maternal morbidity and length
of hospital [when using midwives] has the potential to reduce
the cost of maternity care to women, their infants and the
health care system".
Harvey et al. (1996). Randomized controlled trial of nurse-
midwifery care [in Calgary, AB]. "Birth", 23(3), 128-135.
O'Brien et al. (2010). Comparison of costs and associated outcomes
between women choosing newly integrated autonomous midwifery care and
matched controls: A pilot study [in Alberta]. "JOGC", 32(7), 650-656.
Abstract
Planned home birth for women classified as having no problems
has been found to be safe and cost effective. Women having a home birth
often have no interventions during labour and birth. One intervention
often leads to another and each intervention costs money. Spontaneous
labour and vaginal birth costs less than a cesarean section.
Anderson, R. E., & Anderson, D. A. (1999). The cost-effectiveness of
home birth. "Journal of Nurse-Midwifery", 44(1), 30-35.
Campbell, R., & Macfarlane, A. (1994). Where to be born? The debate
and the evidence (2nd ed.). Oxford: National Perinatal Epidemiology Unit.
Olson, O. (1997). Meta analysis of the safety of home births.
"Birth", 24(1), 4-13.
Rooks, J. P. (1997). Safety in out-of-hospital births in the United
States. In Midwifery and childbirth in America (pp. 345-384).
Philadelphia: Temple University Press.
Sandall et al. (2009). Discussions of findings from a Cochrane review
of midwife-led versus other models of care for childbearing women:
continuity, normality and safety. "Midwifery", 25(1), 8-13.
Tew, M. (1998). Safer childbirth? A critical history of maternity
care (3rd ed.). Published by Free Association Books, 57 Warren Street,
London W1P 5PA, England. ISBN 1-85343-426-4
For information on the requirements to become licensed in a
province/territory see the page containing addresses for
Information Regarding Midwifery Licensure.
Until midwifery legislation is passed there are advocacy
groups in most provinces who provide support for midwives in their
efforts to have legislation passed and put into effect. These
groups lobby politicians to recognize the practice of midwives, and
educate the public regarding midwifery. The licensure of midwives
provides women with another choice for childbirth.