Delivering the ‘new’ Canadian midwifery: the impact on midwifery of integration into the Ontario health care system

Abstract

This paper addresses the impact on midwifery of its recent integration into the provincial health care system in Ontario, Canada. Data are derived from participant-observation, primary and secondary source documents, and key informant interviews. Based on these data, I argue that midwifery has changed throughout the integration process but it has also successfully resisted change. Specifically, the organisation of the midwifery community evolved from an amorphous social movement to a more bureaucratically organised profession. The regulation of midwifery also shifted from direct-regulation by clients to professional self-regulation. The educational model of midwifery also changed from an eclectic apprentice-based approach to a more standardised baccalaureate degree programme. The midwifery model of practice, however, was sustained. Although these changes occurred at the hands of key members of the midwifery community, they were made in response to the structural context of the health care system into which they were attempting to become integrated.

Introducing Midwifery-led Birth Centres to Ontario

“…They were often local women with informal training who played multiple roles, not only attending births but also helping with housework and childcare (Bourgeault 2000). By the turn of the last century, midwives were pushed to the periphery of the maternal health system in favour of a growing medical profession that preferred attending births in a hospital setting.…”

“…It was not until the late 1960s and early 1970s that there was a resurgence of midwifery; this is attributed to British influence and their valuing of midwives, as well as a stream of ideas and advocates coming from the United States (Bourgeault, Benoit & Davis-Floyd 2004). Over time, the social movement grew and the "new" midwifery practice was born, centring on midwives providing support, information and advice to clients in a way that prioritizes the needs and wishes of the pregnant woman (Bourgeault 2000).…”

“…In Ontario, the first important step towards the regulation of midwives was the formation of the Ontario Association of Midwives in 1981 (Bourgeault 2000). In 1983 the Health Professions Legislation Review was established to review health professions in Ontario and the Midwifery Coalition and the Midwifery Task Force of Ontario developed a case to integrate midwifery into the health system (Bourgeault 2000).…”

“…In 1983 the Health Professions Legislation Review was established to review health professions in Ontario and the Midwifery Coalition and the Midwifery Task Force of Ontario developed a case to integrate midwifery into the health system (Bourgeault 2000). By the end of 1993, the Midwifery Act was enacted and the CMO was created.…”

“We Wanted a Birth Experience, not a Medical Experience”: Exploring Canadian Women's Use of Midwifery

“…Midwives also support a woman's choice as to where-home or hospital-she would like to give birth. Although midwifery care is dynamic and thus undergoing changes (Bourgeault, 2000), it nonetheless is focused on shared responsibility and mutual decision-making processes, which falls in sharp contrast to the medicalized pregnancy and childbirth experience wherein professionals are seen as the experts. Turner (2004) explained within a medical model, "the doctor is placed at the center of the healing act.…”