Evidence of meeting #47 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was midwifery.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Emmanuelle Hébert  President, Canadian Association of Midwives
Ellen Blais  Co-Chair, National Aboriginal Council of Midwives
Richard Aucoin  Executive Director, Pest Management Regulatory Agency, Department of Health
Jason Flint  Director, Policy, Communications and Regulatory Affairs Directorate, Pest Management Regulatory Agency, Department of Health
Connie Moase  Director, Health Evaluation Directorate, Pest Management Regulatory Agency, Department of Health

3:30 p.m.

Conservative

The Chair Conservative Ben Lobb

Good afternoon, ladies and gentlemen. Welcome back. We're ready to begin our meeting.

In our first hour we're going to be looking at Bill C-608, an act respecting a national day of the midwife. The author of the bill is here today.

Thank you very much, Ms. Doré Lefebvre. You have 10 minutes to bring some remarks. Go ahead.

3:30 p.m.

NDP

Rosane Doré Lefebvre NDP Alfred-Pellan, QC

Thank you very much, Mr. Chair.

I would first like to thank the hon. members of the Standing Committee on Health for taking the time today to study my bill, Bill C-608, An Act respecting a National Day of the Midwife. I would also like to thank the many midwives who worked with me on this matter.

The reality of midwifery is quite different from coast to coast, be it in the heart of the Northwest Territories or in downtown Toronto. Their openness and generosity have enabled me to better understand their world and the impact their work has on our society. My special thanks go to the Canadian Association of Midwives, the National Aboriginal Council of Midwives and the Ordre des sages-femmes du Québec for their contribution.

Last fall, the House of Commons was unanimously in favour of the bill. As parliamentarians, we were able to show our support for Canadian midwives and our commitment to recognizing May 5 as the National Day of the Midwife.

As you can see, the title of Bill C-608 really reflects its intent: recognizing midwifery by designating May 5 as the National Day of the Midwife.

The World Health Organization introduced the International Day of the Midwife in 1992. That day is recognized in a number of countries around the world. That is why May 5 has been kept as the date for the National Day of the Midwife.

Whether here or abroad, the work of midwives is needed to keep mothers and children healthy. Although the number of midwives is going up every year in Canada, less than 5% of the population has access to their services, which is not enough to meet the demand.

The situation is even more desperate in aboriginal or remote communities, where giving birth is completely different from the reality of big cities. The presence of midwives in remote areas helps communities reconnect with the ancestral practices they hold dear.

It is also important to point out that Canadian midwives are recognized internationally for the quality of their work. We can be very proud of them.

I sincerely believe that the main thing here is to highlight the invaluable work that midwives accomplish daily. That is why I brought forward Bill C-608.

I will be pleased to answer any questions members of the committee may have.

Thank you.

3:35 p.m.

Conservative

The Chair Conservative Ben Lobb

Thank you very much.

Next up, from the Canadian Association of Midwives, is Ms. Hébert.

Go ahead.

3:35 p.m.

Emmanuelle Hébert President, Canadian Association of Midwives

Thank you Mr. Chair and committee members for the opportunity to appear today to testify as part of the committee’s study of Bill C-608, An Act respecting a National Day of the Midwife. I would also like to thank the sponsor of the bill, member of Parliament Rosane Doré Lefebvre who introduced this bill in the House of Commons and who has personally championed the cause of midwifery in Canada. We also extend our gratitude to member of Parliament Peggy Nash for the work that she has done to establish a National Day of the Midwife in Canada.

The International Day of the Midwife was formally established in 1992 by the International Confederation of Midwives (ICM). Since then, every year, May 5 marks the day of celebration for midwifery globally, a day that reminds the world of the essential role that midwives play in ensuring healthy outcomes for mothers and their newborns. Statements in support of International Day of the Midwife have been issued by the United Nations Population Fund (UNFPA), the International Federation of Gynecology and Obstetrics (FIGO) and by the World Health Organization (WHO).

The Canadian Association of Midwives firmly believes that Bill C-608 is an important step in showing appreciation for the vital contribution that midwives make to the delivery of safe, quality maternity care to Canadian families and to the important role that midwives play in delivering thousands of healthy Canadian babies.

We would like to thank committee members Dr. Colin Carrie, Dr. Hedy Fry and members of Parliament Lois Brown and Peggy Nash who have echoed this appreciation in their statements delivered in the House of Commons in 2013 and in 2014 in recognition of May 5 as the International Day of the Midwife. And of course, CAM is very grateful to all political parties for the unanimous support the bill has received to date.

The Canadian Association of Midwives is the national organization representing midwives and the profession of midwifery in Canada. CAM's mission is to provide leadership and advocacy for midwifery as a regulated, publicly funded and vital part of the primary maternity care system in all Canadian jurisdictions.

CAM also works to support the interests and objectives of 13 provincial and territorial midwifery associations, as well as the National Aboriginal Council of Midwives (NACM). There are currently just over 1,300 practising midwives in Canada. Midwifery in Canada provides a model of care that is evidence-based, women-centred, safe, and cost-effective. Registered midwives are health professionals who provide primary care to women and their babies during pregnancy, birth and the postpartum period. They are often the first point of entry to maternity services, and are fully responsible for clinical decisions and the management of care within their scope of practice.

Midwifery models of care vary across the country, but all are based on the principles of continuity of care provider, informed choice, and choice of birth place, such as hospitals, birth centres and homes.

Midwives provide a complete course of low-risk prenatal, intrapartum and postnatal care and services for mothers and their newborns. These include physical examinations, screening and diagnostic tests, the assessment of risk and abnormal conditions, and the conduct of normal vaginal deliveries.

Midwives work in collaboration with other health professionals, and consult with or refer individuals to medical specialists as appropriate. In jurisdictions where midwives work to the fullest scope, midwifery practice includes epidural monitoring, induction for post-term pregnancy and augmentation of labour by pharmacological means, prescription or fitting of contraceptives, baby care beyond the six-week postpartum period, and many other aspects of primary care.

Midwives are experts in normal births and therefore help to reduce high rates of interventions. Women who experience midwife-led continuity models of care are less likely to experience antenatal hospitalization, regional analgesia and episiotomy, and their newborns are more likely to have a shorter hospital stay and fewer readmissions.

Midwifery services also help to reduce wait times in emergency rooms because midwives are on-call and directly accessible to their clients 24 hours a day, seven days a week.

According to statistics from Ontario, midwives currently achieve caesarean section rates that match the World Health Organization's recommended rate of 15%. If midwifery care was widely instituted, this reduction alone could potentially save millions of dollars a year in health care spending.

There are seven universities in five provinces offering a four-year midwifery education baccalaureate program, and a number of community-based midwifery education programs in first nations and Inuit communities. In spite of this, only 2% to 5% of women in Canada currently have access to midwifery care services.

And why is this? In New Brunswick, Prince Edward Island, Newfoundland and Labrador, and in the Yukon, the profession is still unregulated and unsupported by the public health care system, so families do not have access to midwifery care.

In federal jurisdictions, such as on reserve, penitentiaries and military bases, communities face numerous barriers when attempting to implement midwifery services. These attempts most often result in failure to improve health services and to offer birthing services closer to home.

The World Health Organization, UN agencies and other global partners have identified midwives as key to achieving reductions in maternal and infant mortality. Through the Muskoka initiative and more recent investments by the government in international maternal, newborn and child health, Canada has played a role globally in helping to increase women’s access to quality maternity care.

However, a 2013 UNICEF report found that Canada domestically ranked 22 out of 29 developed countries for infant mortality rates. This concerning figure is mostly attributed to the higher rates among aboriginal communities where women must leave their community for weeks to give birth in urban centres, away from their families and support systems.

Midwifery can play a significant role in ensuring better access to care for women and their babies and CAM looks forward to opportunities to work with the federal government and with the provinces and territories to improve access to maternal and newborn health care in Canada.

In June 2017, Canada will host the world’s triennial global midwifery congress in Toronto. Over 4,000 midwives and maternity care providers from around the globe will be in Canada to learn and discuss on issues regarding global maternal, newborn and child health. This will be a one of a kind opportunity for us to demonstrate to the world Canada’s contributions and to share what Canada is doing within its own borders to ensure fair and equitable maternity care for all Canadians.

Evidence from around the world demonstrates that midwives are essential to improving the lives of mothers and babies. Let us work together to ensure that in June of 2017, when midwives and health professionals from around the world gather in Toronto, that Canada is seen as a leader in the delivery of safe, equitable and cost-effective community-based maternal, newborn and child health services for all Canadians and continues to be a global leader in this area.

We applaud the government's Muskoka initiative and more recent global investments in maternal, newborn and child health that have helped to train midwives and skilled birth attendants, and increased women's access to quality midwifery services internationally.

The Canadian Association of Midwives continues to play an important role in ensuring Canadian expertise is being fully utilized to strengthen midwifery globally.

In closing, Canadian midwifery is a model of maternity care that provides excellent patient satisfaction, while decreasing rates of intervention and providing cost-effective care. This model is especially suited for providing care in rural and remote communities where transportation costs to transfer patients are staggeringly high.

Midwives benefit from flexibility and sustainability when they work to their fullest scope of practice, which is why this model should be explored and expanded by those looking for innovative models of care.

We are thrilled to be hosting the ICM global midwifery congress in Canada in 2017 and see this as an opportunity for Canada to shine even more on the global stage. Bill C-608 is an important step towards recognizing the growing profession of midwifery and the essential role midwives play in the delivery of maternity care and its potential to enhance our health care system across the country.

Thank you for the opportunity to appear before the committee and I look forward to any questions you may have.

3:45 p.m.

Conservative

The Chair Conservative Ben Lobb

Thank you very much.

Next up, from the National Aboriginal Council of Midwives, we have Ms. Blais.

Go ahead.

3:45 p.m.

Ellen Blais Co-Chair, National Aboriginal Council of Midwives

Good afternoon. My name is Ellen Kanika Tsi Tsa Blais. I am an aboriginal midwife from the Oneida Nation of the Thames, which is one of the six nations of the Iroquois Confederacy. I am from the Haudenosaunee territory, the people of the longhouse, and I am honoured to be here today as co-chair of the National Aboriginal Council of Midwives, otherwise known as NACM. I want to thank the peoples of the Algonquin nation whose unceded territory I am visiting today.

Thank you, Mr. Chairman and committee members, for the opportunity to appear today to testify as part of the committee's study on Bill C-608, an act respecting a national day of the midwife. I would also like to thank the sponsor of the bill, member of Parliament Rosane Doré Lefebvre, who introduced this bill, and who has personally championed the cause of midwifery in Canada and is helping bring to light the challenges we face in our communities. We also extend our gratitude to member of Parliament Peggy Nash for the work she has done to establish a national day of the midwife in Canada.

NACM believes that Bill C-608 is an important step in showing appreciation for the vital contribution that midwives make to the delivery of maternity care in Canada. NACM also believes this bill will bring much needed visibility to the work of aboriginal midwives in supporting health and healing within our communities. Aboriginal midwives have always worked in the community, carrying the cultural knowledge for safe childbirth, yet our work has become almost invisible over the past 100 years due to the medicalization of childbirth. We are working hard to reclaim our role, and legislation such as Bill C-608 offers further support to this essential work.

We would like to thank committee members Dr. Colin Carrie, Dr. Hedy Fry, and members of Parliament Lois Brown and Peggy Nash, who have echoed this appreciation in their statements in the House of Commons. NACM is also grateful to all political parties for the unanimous support the bill has received to date.

NACM's vision is to see aboriginal midwives practising in every aboriginal community. We believe that aboriginal midwives working in every aboriginal community is a safe and cost-effective way to deliver maternity services. Our knowledge and role in protecting, caring for, and honouring women as life-givers are essential for community healing and connect us all.

NACM is a diverse group of indigenous midwives, midwife elders, and student midwives from all regions of Canada. Members include both registered midwives and midwives practising under certain exemption clauses of provincial health legislation. We promote excellence in reproductive care for Inuit, first nations, and Métis women. We advocate for the restoration of indigenous midwifery education and choice of birthplace for all aboriginal communities, consistent with the UN Declaration on the Rights of Indigenous Peoples.

Aboriginal midwives bring wellness back into the community and enable the creation of sacred, powerful healing spaces. An aboriginal midwife is a committed primary health care provider who is fully responsible for clinical decisions and the management of low-risk prenatal, intrapartum, and postnatal care. She promotes breastfeeding, nutrition, and parenting skills. She is a leader, mentor, and keeper of ceremonies. Aboriginal midwives work with other health care professionals, including doctors, pediatricians, or other specialists when needed, and advocate for culturally safe care.

In 2012, NACM was recognized by the Health Council of Canada as a promising practice in aboriginal health. There are currently 11 midwifery practices in Canada dedicated to providing care in aboriginal communities. Our work is promising, but the road ahead is long. Today, very few aboriginal communities have access to midwives, and most women give birth outside their communities.

I invite you to take a moment and imagine your families. You are about to become a grandparent for the first time. You are thrilled. You have been waiting for this moment for months, helping your daughter prepare for this beautiful time. You are eager to meet your first grandchild. Your daughter is nervous about the birth and you reassure her. You have made a small gift for the baby and you give it to your daughter when you see her off at the airport. She is flying to Thunder Bay to have her baby as per the evacuation policy, since the community you live in does not have maternity services. You bid her an emotional goodbye. You try to stay in touch by phone over the weeks while she waits for labour to begin and you worry about how you are going to pay for phone bills you cannot afford.

Your family gathers at the home of her husband and awaits the news of the baby's arrival. The next afternoon, you learn that the baby was born by C-section that morning. It's a girl. You and your daughter's husband long desperately to hold the baby, to welcome her. You are told that you will able to in about a week's time.

When your daughter returns, she is emotional and exhausted after a long and lonely four weeks away. She thought that she would breastfeed her baby, as she learned it was the best choice to make, but she was not able to find the support she needed while so far away. You know that she has started to formula-feed her baby, and you once again worry about the cost. You thought you would be overjoyed to meet your grandchild. Instead, you think about how much you have already missed.

This is what birth looks like today in most of our communities. Every day families are separated and women give birth alone, even as a growing body of research points to the health and social costs of this practice.

Developing maternity services closer to home is an integral part of the healing process in aboriginal communities. Aboriginal midwives respect birth as a healthy physiologic process, and honour each birth as a spiritual journey. We believe aboriginal women have the inherent right to choose our caregivers and be active decision-makers in our health. Working closely with women to restore identity and health from the time of birth enables us to heal from historical and ongoing trauma, addictions, and violence. When birth is absent, so is the power and joy of the birth story, and within it, the threads of connections to oneself, family, community, and the cosmos.

In many cases aboriginal midwives are the first and only health professionals a woman sees throughout her pregnancy. We have a unique opportunity to build trusting relationships with the health care system that have a ripple effect into the health of the family and the community. For example, the success of the Inuulitsivik Health Centre, one of three Nunavut birthing centres, has been recognized on several international platforms, including the World Health Organization. Since 1986, locally trained Inuit midwives have been providing cost-effective care along the Hudson Bay coast. Birth evacuations have since dropped from 91% in 1983 to just 9% in 1998, drastically cutting costs. Bringing birth closer to home is possible.

In federal jurisdictions such as reserves, communities face significant barriers when attempting to implement midwifery services. At this time there is no federal funding for midwives to practice on reserve except for reallocated funds transferred to the First Nations Health Authority in British Columbia.

I once had the honour of being involved in a young woman's healing through the transformative power of birth with aboriginal midwives in Toronto. This woman was from one of the Cree nations from western Canada. She had already given birth to several babies, each one apprehended into the child welfare system while living out west. She had sustained a childhood full of sexual abuse from family members who, while attending residential school, had not experienced a healthy and loving childhood but had experienced only sexual, physical, and emotional abuse from their teachers. She began taking drugs to numb the pain. When she arrived in Toronto she was pregnant, and was supported to connect with aboriginal midwives for her birth.

She was convinced she did not have the capacity to care for her baby, and was planning to relinquish him at birth to the Children's Aid Society. The aboriginal midwives surrounded her at the birth with care and compassion, singing and drumming her baby into the world. She told me that at that time she felt like all of her ancestors were there at this birth. Her baby was born at sunrise. Later on his spirit name was given to him by an elder who was not aware of the time of his birth but through the connection of spirit gave him the name “He who brings in the light”. From that moment on, she began to learn how to care for herself. After a year of hard work, inspired and supported by her aboriginal midwives, she brought her son home to stay.

Globally, NACM is among the first national professional associations of indigenous midwives. Worldwide, other indigenous midwives look to NACM as leaders. In 2017 the global midwifery conference will be hosted in Toronto, and NACM will have the opportunity to showcase our groundbreaking on the global stage.

Bill C-608 is a first step to recognizing the essential role that midwives play in ensuring the health of our communities. It is one action that continues to bring visibility to our work of creating strong identities for our children, strength for our women, deep bonds in our families, and a healthy future for our communities.

I want to close with a prayer by Katsi Cook, a mentor midwife, that we use in our medicine circle for blessing births: Relax where you are and feel your weight supported by Mother Earth. Breathe in the oxygen. It is part of the sky and part of each one of us. I give thanks, for peacefully you are born. I pray that peacefully your life will be ongoing, because as I think of you clearly, I know you will always be loved.

Thank you for the opportunity to appear before this committee, and I look forward to any questions you may have.

3:55 p.m.

Conservative

The Chair Conservative Ben Lobb

Thank you very much.

First up in our round of questions is Ms. Davies.

Go ahead, please.

3:55 p.m.

NDP

Libby Davies NDP Vancouver East, BC

Thank you very much, Mr. Chairperson.

First of all, to Madam Doré Lefebvre, thank you so much for appearing today. It's just a delight to have you here with this very important bill. I think we all know that you've done a lot of work on this bill and you've had tremendous support across the country. It's truly wonderful that it was adopted unanimously at second reading in the House of Commons, and here we are today at committee. Thank you for being here to speak to your bill.

To both of our witnesses, thank you also for being here. I feel very happy that we can give some support and visibility to this issue. You do incredible work, yet Canadians know very little about what you do and who you are. I think just your testimony today, and the stories you've told us, and the prayer you've repeated for us, give us an understanding of how important the work is that you do and the difference it makes in individual lives and the life of a whole community.

I don't want to use the word “shocking”, but it's really quite incredible that there are only 1,300 of you across the country. You're actually a very small group of women who are doing incredible work. I wish we could say that it would triple and quadruple. I think the goal, the philosophy, of closer to home, to being in-home, is so important. It's something that changes a woman's experience in her life about childbirth. Thank you for what you do.

Of course the bill is very important because it does give recognition to May 5. It's already an international day, but it's important that we give recognition to this day in Canada.

I don't really want to ask you about what you do so much, as time is limited. I want to focus more, I think, on the obstacles and what challenges you have. In particular, it's very disappointing to know that there aren't federal dollars for midwives on reserve and in aboriginal communities, excepting, I think you said, through other transfers with B.C. I do remember, from former discussions we've had with you, that there is an issue involving something to do with the classifications at the Treasury Board. I would love it if you could remind us of what this issue is. I figure at least there is something that we might be able to follow up on. I hope the bill will go through and it will go back to the House, but maybe there's another matter that this health committee could follow up on. It is clearly within federal jurisdiction.

I wonder if both of you could remind us about this issue that you've been battling away on at the Treasury Board for so long, and maybe we can assist in some way.

4 p.m.

Co-Chair, National Aboriginal Council of Midwives

Ellen Blais

Thank you very much, Ms. Davies, for your comment. I appreciate that and your question.

I think an important barrier has been identified in terms of having equal access to midwifery care across Canada and ensuring equity across Canada as well for midwifery care. Currently there is no occupational classification with the Treasury Board to enable federal governments to hire midwives under federal jurisdictions. That's one of the things we're really working on, trying to find a pathway to make that more noticeable.

4 p.m.

NDP

Libby Davies NDP Vancouver East, BC

How long have you been working on that, by the way?

4 p.m.

President, Canadian Association of Midwives

4 p.m.

Co-Chair, National Aboriginal Council of Midwives

Ellen Blais

It's over two years now.

4 p.m.

NDP

Libby Davies NDP Vancouver East, BC

What does the absence of that classification mean? If you don't have that classification, does that mean midwives can't be hired through federal programs? What does it mean in practical terms?

4 p.m.

Co-Chair, National Aboriginal Council of Midwives

Ellen Blais

On reserves, for example, or in federal jurisdictions right now there are a number of job classifications. For example, doctors and other health care professionals can be hired to work on reserve, but there is no federal classification to hire a midwife, so it simply isn't possible.

4 p.m.

NDP

Libby Davies NDP Vancouver East, BC

Thank you for raising this, or for responding to my question.

Chairperson, I know we're dealing with a bill today, but I'm actually hoping that as a result of hearing from our witnesses today, possibly this committee, through you as the chair, would be willing to write a letter to the Minister of Health and to the Treasury Board just encouraging and supporting that this classification get dealt with. I'm not even posing it as a formal motion, but I think if there's an interest, I'm sure you, as the chair, could write a very appropriate and sensible letter just pointing out this obstacle that still exists.

I would like to put that forward and hope that other members of the committee might support that.

Thank you.

4 p.m.

Conservative

The Chair Conservative Ben Lobb

You still have some time.

4 p.m.

NDP

Libby Davies NDP Vancouver East, BC

I'm happy to pass it around and make sure that others get heard.

4 p.m.

Conservative

The Chair Conservative Ben Lobb

Okay. Next up we have Mr. Lunney.

Go ahead, sir.

4 p.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

Thank you very much, Mr. Chair.

I welcome our witnesses today.

Congratulations to you, Madam Rosane Doré Lefebvre, for bringing this issue forward. I think you saw from the response in the House, the unanimous agreement, that we all accept your idea as a very worthy one.

I'm interested in the fact that when you speak en français you regard midwives as sage-femmes. That's a very interesting term. I don't know where the term “midwife” came from; it's been in use a long time. To say “sage-femme” implies something that's a very useful concept in understanding the role of a midwife in helping women who are having babies, who are usually young women and need the benefit of a sage-femme, someone with experience, someone who has been around the birthing experience, especially in our day and age when in regard to such knowledge there's a lot of fearmongering. There's a lot of fear related to childbirth, which I think for most births is unnecessary. The majority of births—far and beyond the majority—still are very low risk and are a normal health experience in the human family.

I appreciate your being here now to have this discussion. You mentioned a few interesting things. Part of your remarks was about how the presence of midwives helps communities, and I think it's a tragedy when women have to go far away from their families and their communities to have babies. It's certainly better to have them right in their own communities.

Also, if I can speak for the dads, I think having the dad there is probably a good idea, because they're supposed to have a role in raising a child as well, and increasingly that's a problem. For the dad to miss out on the birthing event is a real tragedy of another order. It seems to me that the dad should be engaging in conversations with the baby, who after all is in an aqueous medium, and as hearing is the first of our higher senses to develop, the babies therefore are sensitive to the sounds around them. Therefore, the baby also is much more comfortable being born in their own environment. A home birth is probably preferable, because those are the sounds the baby is used to, and the music they're used to, and the normal sounds in their own home environment are far different from what you find in a hospital setting.

I think there's a lot of interest today.

Ellen, you mentioned the example of a young mom who wanted to breastfeed but there was no one there, really, in a busy hospital environment to help her through the practical challenges. There's a missed opportunity. For most babies, they need just a little gentle coaching and assistance. There's a lot of attention to skin-on-skin contact and how important that is for babies at the beginning, so whisking them away, wrapping them up, and putting them somewhere else immediately is not the best way to respond.

I think midwives certainly excel in all of those things related to birth. You have a tremendous role in getting that message out, in helping babies come into the world effectively and in a more comfortable manner, and in helping the mothers to get off to a good start. Also, I'm going to put a word back in for the dads, because they should be involved. I think most midwives would want to have the dad there as well if possible.

Anyway, I just want to say that I think because there are only 1,400 of you.... I thought it was 1,400, but I think Ms. Davies said there were 1,300 registered midwives. First of all, can you confirm the number? Also, for the record, would you tell us about the training of midwives in Canada? I think a lot of Canadians don't understand the formal training that you undergo today.

4:05 p.m.

President, Canadian Association of Midwives

Emmanuelle Hébert

Thank you very much for your question. I will answer it in French.

Canada has 1,300 registered midwives right now, and this number is increasing very rapidly. Our profession is growing quickly, given that seven universities now offer midwifery education. They offer a bachelor's degree that can be completed in four years or even in four and a half years in some places. The training is very practical, providing midwifery students with many opportunities to work with pregnant women and babies.

Training programs are also offered in first nations communities, in general, and Inuit communities across Canada. Those few training programs are really tailored to the needs of aboriginal midwives. There is also a bridging program for midwives with training from abroad. Midwives from Europe, Latin America and the United States can benefit from a fast-track program and come to work in Canada. That is why the midwifery profession is growing quite significantly at the moment. We hope that it will double, or even triple, quite quickly.

In Canada, midwives are quite independent in their work in the sense that they practice their profession primarily outside hospitals. They are responsible for prenatal follow-ups and, after delivery, postnatal follow-ups, as well as normal deliveries by healthy women. Internationally trained midwives need to be retrained because the Canadian midwifery model of care is not used in all the countries. Therefore, midwives who come from abroad must often relearn this independence and develop sound clinical judgment to be able to work independently.

Our training programs are currently recognized internationally. They are considered the gold standard around the world for helping midwives develop independence and clinical judgment. More and more countries, where the training was not at university level or was not a four-year university degree, are trying to increase midwives' level of training to achieve a level comparable to the one we have here. In short, our Canadian midwives are extremely well trained.

4:10 p.m.

Conservative

James Lunney Conservative Nanaimo—Alberni, BC

Thanks.

Can I ask about payment for your service? In most provinces and jurisdictions, is it considered an insured service, or are payments all private?

4:10 p.m.

President, Canadian Association of Midwives

Emmanuelle Hébert

In provinces where the profession is regulated, any related services are covered under provincial health care plans. That is what we are recommending for all of Canada.

4:10 p.m.

Conservative

The Chair Conservative Ben Lobb

Thank you very much, Mr. Lunney.

We're now up to Ms. St-Denis.

Go ahead.

4:10 p.m.

Liberal

Lise St-Denis Liberal Saint-Maurice—Champlain, QC

Thank you, Mr. Chair.

Ms. Hébert, do you think that proposing this National Day of the Midwife will help this profession gain official recognition? If there is an official day, people may talk more about it but will it actually give midwives a more official status?

4:10 p.m.

President, Canadian Association of Midwives

Emmanuelle Hébert

I think that any recognition of the role of midwives is currently more than welcome. This is a major first step toward recognition at the federal level of the important part midwives play in primary maternity care in Canada.

Will it ensure that the profession will change or be recognized with a capital “R” overnight? Of course not, but I think it really is a major step in the right direction.