Thank you, Mr. Chair and committee members, for the opportunity to appear today to contribute to the study of best practices and federal barriers related to scope of practice and skills training of healthcare professionals.
My name is Emmanuelle Hébert, President of the Canadian Association of Midwives, registered midwife and professor at the Université du Québec à Trois-Rivières.
The Canadian Association of Midwives is the national organization representing midwives and the profession of midwifery in Canada. The association's mission is to provide leadership and advocacy for midwifery as a regulated, publicly founded and vital part of the primary maternity care system in all Canadian jurisdictions.
The Canadian Association of Midwives also works to support the interests and objectives of 13 provincial and territorial midwifery associations, as well as the National Aboriginal Council of Midwives. There are currently just over 1,300 practising midwives in Canada.
Registered midwives are health professionals who provide primary care to women and their babies during pregnancy, birth and the post-partum 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. Models of care vary across the country, but are based on the principles of continuity of care provider, informed choice, and the choice of birth place which includes hospitals, birth centres and homes.
Midwives regularly interact with a wide variety of health care professionals and social services workers in order to provide optimal care for clients. These include obstetricians and gynecologists, family physicians, pediatricians, nurses, radiologists, psychiatrists, paramedics, social workers, pharmacists, dieticians, and many more.
Collaboration and consultation with other health care providers is integral to the scope and practice of midwifery. Midwives, together with physicians and nurses, are actively exploring collaborative models of care and multidisciplinary practice to help address shortages of care providers and ensure women's access to maternity services, particularly in rural and remote communities.
Let's talk about midwifery training. The midwifery education program is a four-year direct entry baccalaureate program in midwifery. Seven Canadian universities in five provinces offer the midwifery education program. There are also three community-based midwifery education programs located in first nations and Inuit communities that specifically address the needs of aboriginal peoples.
Three bridging programs also exist in Canada, designed to help internationally educated midwives learn how to use their skills in a Canadian context; one in British Columbia, one in Ontario and one in Quebec. All students graduating from the midwifery baccalaureate programs take the Canadian midwifery registration examination which demonstrates that they have the core competencies and meet a common standard for entry level competency in all Canadian jurisdictions. All midwifery education programs are based on the same standards of education to train midwives as autonomous primary health care providers able to practise in all provinces and territories.
In jurisdictions where midwives work to their full scope, midwifery practice includes epidural monitoring, induction for post-term pregnancy and augmentation of labour by pharmacological means, prescription or fitting of contraceptives, well women and well baby care beyond the six-week post-partum period, and other aspects of primary care.
Scopes of practice reviews to amend drug schedules and expand on the authorized acts that midwives may perform have been completed. The objective is to harmonize high standards of midwifery care across Canada, reduce barriers to interprofessional collaboration and keep pace with a changing maternity and newborn care environment.
In every jurisdiction where midwifery is regulated, the provincial and territorial colleges are responsible for registering competent, qualified midwives and establishing, monitoring and upholding standards of practice.
The Canadian Midwifery Regulators Consortium is a body that groups together the provincial and territorial regulatory bodies. It has identified competencies that are common across all jurisdictions, covering antepartum care, care during labour and birth, postpartum care of the woman, care of the newborn and young infant, breast feeding, well woman care, education and counseling, and professional, interprofessional and legal issues.
Regulatory authorities further specify advanced competencies that midwives with the necessary training and certification may perform in certain situations or practice settings. In some rural or remote communities for example, midwives work to an expanded scope and provide a broader range of services to meet the needs of the population. Definitions of advanced—versus entry-level—competencies vary according to the regulatory framework in each province and territory.
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. This will be a unique opportunity for us to show the world Canada's contributions and to highlight what we do within our own borders to provide fair and equitable maternity care to all of the population.
In order to optimize that visibility in Canada, the Canadian Association of Midwives believes that we should ensure that federal mechanisms are in place to allow communities to hire midwives to deliver maternity and newborn care services. Midwifery is not listed as a recognized profession under the Health Services Occupational Group Structure within the Treasury Board of Canada. This lack of an occupational classification has been identified as a barrier to midwives being hired by communities under federal jurisdiction for service delivery.
Maternal and child health statistics in aboriginal communities fall well below that of the rest of Canada. As the rest of Canada's fertility rates decline, the fertility rates of first nations and Inuit peoples increase. This is in the midst of a severe shortage of maternity and newborn health care providers.
These communities are already underserved and will feel the effects of this crisis disproportionately in the coming years. It is therefore crucial that birth care be brought back to communities and that access to midwifery care services in all aboriginal communities be provided.
Since April 2013, the Government of Canada has been providing student loan forgiveness to eligible family doctors, residents in family medicine, nurse practitioners, and nurses who work in rural or remote communities. Including midwives in this incentive program would increase the outflow of maternity care providers to rural and remote communities.
In New Brunswick, Prince Edward Island, Newfoundland and Labrador and in the Yukon, the profession of midwifery is still not regulated. CAM is working with its provincial and territorial partners and stakeholders to support the regulation of the profession in all jurisdictions.
As stated in the prestigious and well-respected Lancet series published in June 2014, midwifery plays an essential and unique role in ensuring safe, quality and cost effective care to women and babies here and around the world.
Thank you for the opportunity to appear before the committee. I look forward to any questions you may have.
Thank you very much.