Midwifery in Canada

Welcome to the first (but hopefully not last!) guest writer on Belly Tales! Melissa, author extraordinaire from A womb of her own has been gracious enough to write about the Canadian midwifery system for us. Melissa first became interested in midwifery through her anti-racist feminist activisim, and ended up writing a master’s thesis in Women’s Studies on midwifery in Canada. Then she realized that she actually needed to stop writing and start doing, so now she’s a first year student midwife in Toronto, Ontario. Thank you so much for sharing your thoughts with us, Melissa! (And, to all you other foreign student midwives out there, if you’d like to write an article for Belly Tales about midwifery in your country, we’d certainly love to learn more about midwifery around the world! Don’t be shy!) And so, without further adieu, here we go:

Before I explain the current midwifery situation in Canada, it’s important to talk a bit about history. I strongly believe that we need to know where we came from to understand where we’re going. Midwifery was criminalized in Canada in 1865, two years before we became a nation. That doesn’t mean that midwives stopped practicing. In fact, since obstetrical training was generally only a few days of doctors’ education, many physicians in rural area worked in conjunction with midwives, or even looked to them for mentorship. Not surprisingly, many women preferred midwives to doctors, and it wasn’t until births moved to hospitals in the early 20th century that midwifery really started to decline.

Midwifery wasn’t a coherent set of practices or philosophies. Many women who immigrated to Canada had midwifery knowledge. Aboriginal women have been practicing midwifery as long as they’ve lived on this land. Practices, therefore, were as diverse as the women who birthed babies.

Aboriginal midwifery has played a vital role in Canadian history. Aboriginal midwives played central roles in Aboriginal communities, as healers, teachers, spiritual and moral figures, and as women’s helpers. When European colonizers came to Canada, Aboriginal midwives used their skills to catch their babies, and in some cases acted as cultural liaisons.

This important role was not given the respect it needed by white Canadians. Concerned with health conditions in the North, the Canadian government forced pregnant Aboriginal women to leave their homes and give birth in hospitals in the South. While midwifery in the North is starting to come back, these evacuations continue today. Aboriginal women who are deemed “high risk” are forced to leave their homes and families and stay in Southern hospitals, sometimes for weeks. Sometimes they don’t speak the language. Cultural practices, birth traditions and the importance of family in the birth process are ignored. Aboriginal people worry about the effects of children being born so far from home. This practice has also meant the decimation of the traditional Aboriginal midwife. Canada’s history of residential schools, where Native children were removed from their communities and taught that white culture was superior, has also helped to erode Aboriginal midwifery. Given the important role that midwives played in Aboriginal communities, it can be argued that the erosion of Aboriginal midwifery is tantamount to the erosion of Aboriginal communities themselves.

When midwifery was eventually legalized in Ontario, Aboriginal women asked that Aboriginal midwives be exempt from regulation. Due to the history of abuse and degradation by the Canadian government, Native people have been skeptical about the benefits of state interventions. The result of this is the Aboriginal Midwives exemption clause in the Ontario Midwifery Act. It states that Aboriginal people can self-designate as midwives, and practice in ways that they define. Aboriginal midwives have a different educational system and different midwifery practices than registered midwives. (This doesn’t mean that there’s no overlap; some Native women become registered midwives instead of Aboriginal midwives).

The 1980s saw the resurgence of midwifery in Canada. It had never disappeared, but a combination of political factors made midwifery palatable to the public once again. One of these factors was the growing consumer advocacy movement in health care. People were questioning biomedical frameworks and hierarchies of power. The other important factor was the growing feminist movement, which sought to put birth back into women’s hands. These influences are integral parts of midwifery regulation today.

Midwifery was finally legalized in Ontario in 1994. Canada was the last industrialized nation to decriminalize midwifery. Other provinces followed, and today midwifery is legally recognized almost everywhere in Canada. With the exception of Alberta, it is fully funded everywhere that it is legal. I’m going to turn my attention now to Ontario, partly because that’s where I live and go to school, and partly because other provinces have followed Ontario’s midwifery model.

Midwives have been incredibly successful in organizing. Our services are completely funded for any woman living in Ontario, regardless of whether she is a Canadian citizen. We work in independent practices with other midwives. We have complete autonomy over low-risk births, and in many cases of medical complications we remain primary caregivers.

Midwifery is based on three principles: informed choice, choice of birthplace, and continuity of care. We work with women throughout pregnancy, birth, and for six weeks postpartum. During this period of time, we’re women’s primary caregivers. We support women giving birth in homes and hospitals. In Ontario birth clinics aren’t allowed yet, although some exist under the radar.

Those of us trained in Ontario go through a four-year university program. The first year and a half is devoted to courses in biology, social sciences and women’s studies. During the second part of the program, we do rotations across the province in midwifery clinics.
We see pregnancy as normal and natural and rarely in need of medical intervention. My personal philosophy, which is shared by other midwifes, is that pregnancy is a special time in women’s lives, and should be respected as such. This means that the birth of a “perfect” child isn’t the most important outcome of pregnancy. We need to understand pregnancy as a cultural and spiritual part of women’s lives. Furthermore, the needs of a fetus are compatible with the needs of its mother; if we care for women, the needs of their babies will be met.

Midwifery in Ontario takes a holistic approach to health. We work with women’s families and communities, as women define them. We work within women’s cultural frameworks. We respect women’s spiritual understandings of pregnancy and birth.

This may sound awfully idealistic. I’m hesitant to paint such a rosy picture of midwifery in Canada. To be sure, midwifery regulation has had some very positive impacts on the way we practice, particularly in terms of being able to offer our work free of charge. On the other hand, we have a high C-section rate. Many of us fear that the number of hospital births we attend is leading to the erosion of home birth in Canada. Some of the regulations have not benefited the women we serve, but rather have been put in place to protect us legally. Our clients in some ways have fewer choices than they had before legislation.

Another important thing to consider is that midwifery is still a predominantly a white space. Because of systemic racism, midwives of colour were excluded from the regulatory process. Many women of colour also feel that midwifery is not a welcoming place, and that their needs aren’t met in the education programs or when practicing. Furthermore, while there are probably thousands of immigrant women living in Ontario with midwifery skills, it is very difficult to get foreign skills recognized. I have written extensively about this on my blog. While I think that this is a critical issue, for the sake of space I urge you to take a look at my website for more information about this. (Start with In which Melissa is schocked by racism, then move on to When do our priorities make us complicit in racism?, followed by Racism and Reproduction and Creative projects for white folks working against racism and go from there).

Midwifery, one could say, is Canada’s oldest and youngest profession. We’re still dealing with a lot of growing pains. But many of us are intensely political and committed to issues of equity and reproductive justice. We have a passion to work with women, as the word midwifery implies, and will continue to work to provide women with the best maternity care possible.