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.
4:10 p.m.
Co-Chair, National Aboriginal Council of Midwives
I'd like to add to that. We are holding an international congress of midwives in 2017, which would be an opportunity for the government to highlight some of the successes it has had in maternal and child health internationally and perhaps on the national stage as well. Going forward, if we have a national day of the midwife, then we could align that quite well with the International Day of the Midwife.
Thank you.
4:10 p.m.
Liberal
Lise St-Denis Liberal Saint-Maurice—Champlain, QC
I would like to ask a second question, for information purposes.
At the start, I think Ms. Doré Lefebvre said that midwifery is recognized by five provinces. Which ones?
4:10 p.m.
NDP
4:10 p.m.
President, Canadian Association of Midwives
Midwifery is not recognized in three provinces and one territory.
4:10 p.m.
Liberal
Lise St-Denis Liberal Saint-Maurice—Champlain, QC
So it is not recognized in certain provinces and territories.
4:10 p.m.
President, Canadian Association of Midwives
They are Newfoundland and Labrador, New Brunswick, Prince Edward Island and the Yukon.
4:10 p.m.
Conservative
4:10 p.m.
Conservative
Terence Young Conservative Oakville, ON
Thank you, Chair.
Thank you, everyone, for being here today. It's so interesting. I first became aware of the advantage of a doula when my daughter delivered my first grandchild, my granddaughter, two and a half years ago. To have someone dedicated to her and focused on her, especially on the day of delivery, was fantastic for her. She raves about it.
Madam Hébert, could you tell me the difference between a midwife and a doula? That would be helpful.
4:10 p.m.
President, Canadian Association of Midwives
That's a good question and an important one actually.
People often confuse these two roles.
In French, we also use the word “accompagnante”. That person has no clinical responsibility. She helps the mother, the family and the spouse, and plays a supportive role during childbirth. She can also provide breastfeeding support, while the midwife, who has four years of university training, is a true health care professional responsible for monitoring a pregnant woman during her pregnancy, labour and up to six weeks after delivery.
Does that answer your question, Mr. Young?
4:10 p.m.
Conservative
Terence Young Conservative Oakville, ON
That's very helpful. Thank you. I understand that fully.
Again, Madam Hébert, I recently read something written by Dr. Aaron Caughey who is chair of obstetrics and gynecology at Oregon Health and Science University. He said there was no proven benefit to the 60% increase in C-section births in the United States between 1996 and 2009. They were not accompanied by a decrease in rates of death or disease in newborns. The rates for C-sections have been heading back down since 2009.
Could you please comment? Why were they doing all these C-sections if there was no proven benefit?
4:10 p.m.
President, Canadian Association of Midwives
That's a really good question again. Maybe we need to ask them.
I will give you a very personal answer.
I think that there has been an overmedicalization of childbirth for several years now. I am convinced that the people whose decisions led to this process had good intentions. They meant to save more women and babies, and believed that the interventions that were appropriate for at-risk situations were also appropriate for lower-risk pregnancies.
Unfortunately, we have seen that these interventions often cause a chain reaction. They start by using certain anaesthetics during labour, which might make it necessary to use forceps to deliver the baby, might lead to the use of medication to restart the contractions, which can cause distress in babies and therefore lead to higher rates of caesareans. This is what we call a cascade of interventions. This is increasingly being acknowledged in obstetrics.
I don't think all of this was motivated by bad intentions. I think all the doctors had the commendable intention of trying to save lives and babies. However, it did not achieve the desired results and people worldwide now question these interventions.
4:15 p.m.
Co-Chair, National Aboriginal Council of Midwives
I would just like to add to that. The World Health Organization recommends about a 15% C-section rate internationally. We're seeing much higher rates than that now, of course.
4:15 p.m.
Conservative
Terence Young Conservative Oakville, ON
Are they coming down in Canada, in your experience, Madam Blais?
4:15 p.m.
Co-Chair, National Aboriginal Council of Midwives
Definitely with midwives the C-section rates are coming down, but they are not in general.
4:15 p.m.
Conservative
Terence Young Conservative Oakville, ON
Madam Blais, you mentioned that in first nations, most women give birth outside the communities and you mentioned an evacuation policy. Could you please tell the committee whose policy that is? I am unfamiliar with that term.
You also mentioned that in Hudson Bay, because of the birthing centres—91% of births were outside the community—that number is now down to 9%. Can you tell us what has changed?
Thirdly, what is British Columbia doing that is different?
Sorry, it's three questions in one.
4:15 p.m.
Co-Chair, National Aboriginal Council of Midwives
Could you please repeat the first part of the question again?
4:15 p.m.
Conservative
4:15 p.m.
Co-Chair, National Aboriginal Council of Midwives
Well, we're not entirely sure. We believe it is a federal policy, but we don't know where it originated from. It is hard to find that data sometimes. But the policy across Canada is that women leave their home communities around 36 to 37 weeks of pregnancy and are flown out to many thousands of kilometres away. It depends on where they live.
4:15 p.m.
Conservative
Terence Young Conservative Oakville, ON
That sounds like the answer I just got from Madam Hébert. I'm not sure where it came from, but it had unintended consequences. There were good intentions but unintended consequences.
4:15 p.m.
Conservative
Terence Young Conservative Oakville, ON
The second part was about the 91% that went down to 9%. How did that change happen?
4:15 p.m.
Co-Chair, National Aboriginal Council of Midwives
That is because in northern Quebec a treaty was made with the federal government allowing Inuit midwives to work within their own communities, and I believe, to be paid by the federal government through a mechanism within the treaty process. Those Inuit midwives are working in their communities, and because of the relationship that is formed between the midwife and the client herself, very often we have fewer interventions taking place. So those women stay within their communities and they're not flown out, because they have a normal vaginal birth and there's no reason to fly them out.
4:15 p.m.
Conservative
4:15 p.m.
Co-Chair, National Aboriginal Council of Midwives
They now have a tripartite agreement so federal dollars flow to B.C., which then flows that money directly onto reserves, and then they make those choices regarding who the care providers on reserve will be.
