Status of Women Committee on May 6th, 2021

[Naomi Wolfe]

One more time.... Here we go.

I already gave a bit of introduction and context on how I came to midwifery and my personal story, and why I feel midwifery in the north needs to remain in the north.

My biggest recommendation obviously is that we need to maintain midwifery education in the north. I think we also need to rethink the way we deliver midwifery education from an indigenous perspective and how the model of midwifery care works in our indigenous communities. There have been multiple studies done and master's and theses on how this needs to be an expanded interdisciplinary care model and that midwives play a huge role in bridging and supporting the gaps in health care in our northern communities.

Midwives have been filling this responsibility, without all of the recognition that we should have been receiving and the support we should have been receiving this whole time, to improve morbidity and mortality rates in our northern communities. This has always been perceived or labelled as a temporary solution, when it's actually the gold standard solution that we have midwives in the north who are educated and trained in the north, particularly in our first nation communities, so that we have our babies being born at home in the community with the safest care possible.

My number one recommendation is that midwifery education stays in the north, that we find a way to offer midwifery education that is interdisciplinary and focuses on indigenous ways of learning, thinking and doing, and that it's led by our communities and our leaders in a way that is reflective of the needs of our communities.

[The Chair, Conservative, Marilyn Gladu]

Super.

We now go into our first round of questioning then for six minutes with Ms. Sahota.

[Jag Sahota, Conservative, Calgary Skyview, AB]

Thank you, Madam Chair.

Thank you to the witnesses for being here today.

Like I said to the last panel, we're learning a lot about midwives and the role that they play, so I'm going to continue on with my questions around that. My question is for Buffy.

You spoke about being a midwife and now having students. What is it like? When do you guys get involved, at what level and at what stage? How is the continuity of care provided throughout pregnancy and when does it really end? We spoke about mental health issues, helping with that. I'm sure you're not just midwives; you're also acting as their counsellors, their support in many ways. I'm just wondering if you can speak to that, please.

[Buffy Fulton-Breathat]

Our role in people's care commences at conception, so as soon as people find out they're pregnant, they're welcomed into our midwifery practice. Most people meet their midwife at seven or eight weeks of pregnancy, and then we maintain that involvement until six weeks postpartum. Our mandate is to care both for mothers and newborns until six weeks postpartum.

Yes, you're right, it does involve more than just the provision of hands-on care. It's a unique relationship. Without going beyond our scope of practice, we're not counsellors; however, we do end up being advocates for assisting our clients to find services, particularly during COVID when there has been a significant impact on people's mental health and their feelings of safety around where they're giving birth, who's taking care of them, how many people are they being exposed to, all of those pieces.

I think midwifery has serviced very well by having a small team of one or two midwives taking care of somebody, as opposed to saying it's shift change and this is the next nurse who's going to take care of you, or it's shift change and this is the next obstetrician who's going to take care of you.

[Jag Sahota, Conservative, Calgary Skyview, AB]

That's interesting when you said it's a couple of midwives. How does that work? Within the same area, will you find two midwives who are going to be there? There are not going to be changes like from one midwife to the other, to the third one, to the fourth one. I'm just trying to get a sense of how...because you'll get to learn a lot about the household, the health of the mother, the child and all that, which requires having the same midwife, or one or two of them, to be involved.

If you can speak to that, how is that determined? What is the normal course of that?

[Buffy Fulton-Breathat]

You're speaking to continuity of care. Because I cannot be available 24 hours a day, 365 days a year, our clients are assigned a team of two midwives. When I was working full time as a faculty member, I had a team of three midwives to ensure I could teach the learners and still have a known care provider available to the person. At the outset of care, people are assigned their team of midwives, who will rotate and whom they'll meet to ensure that they have developed a relationship and they know the person they're paging at 4 a.m. when they're going into labour.

We're minimizing the number of people involved and ensuring a continuity in that relationship from conception to postpartum.

[The Chair, Conservative, Marilyn Gladu]

I believe Ms. Wolfe also has a response.

[Naomi Wolfe]

I wanted to echo why the need for midwifery expansion in the north is so important, because Buffy talked about these teams of midwives and not having the ability to provide 365-day-a-year care. In our communities, that is happening with midwives who don't have the support or the bodies or the extra midwives to support them in that.

For example, I work and live in an urban centre where there are many other midwives, but I am the only indigenous midwife practising out of my practice, so I provide 365-day care, around-the-clock care. If I am physically not able to be present, then I'm at least reachable for our clients so that I can send them in the right direction for the care they need.

If we don't have more midwives, this happens. We have a midwife in Elliot Lake who is very similar. There are many midwives in smaller, more rural parts of our community that don't have multiple midwives to support them in that work. That's again why it's so important that we have more midwives trained in the north.

[Jag Sahota, Conservative, Calgary Skyview, AB]

You both spoke about how COVID has increased at-home births and the comfort level that clients feel when they can give birth at home as opposed to going to the hospital. Have you also seen an increase in diverse communities, ethnic communities, where they're getting more comfortable using the services of midwives?

Anybody can answer.

[Buffy Fulton-Breathat]

I was just pausing to see if Naomi was going to speak.

Certainly in Sudbury we have noticed that. One of the things we track through BORN, the Better Outcomes Registry and Network, a statistical database, is the ethnicity of the clients for whom we care. As we make inroads into particular ethnic communities we discover, through word of mouth, that trust relationship gets enhanced and built.

Certainly, yes, we have noticed a difference. With Laurentian having a strong international student program, the international students were one of the areas where we noticed a big impact.

[The Chair, Conservative, Marilyn Gladu]

Very good.

Now we'll go to Monsieur Serré for six minutes.

[Marc Serré, Liberal, Nickel Belt, ON]

Thank you, Madam Chair.

I'd like to thank the three witnesses for their commitment to the program, to northern Ontario, and to indigenous people.

My first question is for Ms. Recollet.

Could you tell us more about your recommendations, given that you never had the opportunity to finish your comments about this matter?

[Angela Recollet]

Thank you, Mr. Serré.

I'm sorry, but I don't speak French.

I think you were asking me if I have recommendations on how we can retain the midwifery program in the north. Is that what you asked me?

[Marc Serré, Liberal, Nickel Belt, ON]

That's correct.

[Angela Recollet]

Not bad, eh? I've been hanging around with you too long, or not long enough.

I have several recommendations. You all heard my opening remarks about my passion and compassion for this territory and more importantly, my corporate history with Laurentian University, and several developments, one of which is the Northern Ontario School of Medicine. Again, we are completely disheartened and we have taken on mass advocacy to lobby with government partners. The Northern Ontario School of Medicine was founded upon a tri-cultural relationship in the north with Goyce Kakegamic, Geoff Hudson and Dr. Augustine amongst many grassroots native people, along with our chieftains to ensure that we were creating a school in the north that remains in the north and that we provide expertise to the learners to break down the systemic racism in the health care system by identifying, recruiting and retaining aboriginal people and increasing their success rates in medicine to ensure that we can provide a platform of care for our people by our people.

We have been pushing to ensure that NOSM remains an accrediting body, which it already is, and maintains its degree-granting status. I will not fight with Thunder Bay and Sudbury and have the argument of northeast and northwest. That argument began in 1997, and I want to believe that we established a solution-based approach to ensuring that the medical learners had a vast geography to learn in.

I'm still uncertain how on earth they could have allowed funding that was specific to midwifery to be spent and not accounted for. I also note that other universities in the province of what you now call Ontario are trying to get dibs on our midwifery program, and I am completely against that. This midwifery program, just like NOSM, was created in the north by the north and needs to remain in the north.

I would strongly support and I plead with all of you for your influence to ensure that there is some accountability to retain Laurentian but, more importantly, if there's a way, to make NOSM degree-granting and to make midwifery its own school with its own authority and accountability process, partnered with NOSM.

[Marc Serré, Liberal, Nickel Belt, ON]

Thank you for those recommendations.

Ms. Fulton, 20% of births happen with a midwife. I don't understand why that number's not higher. I had two of my girls with midwifery. Can you go into the details a bit more about the biases? No one understands why this was cut by Laurentian University. No one understands this. Was there a bias within the medical profession, within the university, with the minister of health?

Why was this program cut and why don't we as a society utilize midwifery more often as continuing care?

[Buffy Fulton-Breathat]

To start with the utilization, we are underpopulated as midwives to service the demand, in fact, and about 40% of people in Ontario who wish to have the services of a midwife don't get the services of a midwife. Those are the numbers that the Association of Ontario Midwives put forth. Out of every 10 women who ask for midwifery services, six get it and four do not.

I can speak to my own practice. We have 90 women on a wait-list for the months of July and August alone for our little practice. That's 90 women who will not get the services they're requesting as a consequence of the lack of availability of care providers. Now, that's not a consistent demand around the calendar.

Normally, we do have wait-lists, but the only way that we're going to grow midwifery, address those wait-lists and address those four out of every 10 people who are seeking midwifery and don't get the care is to have a program that, one, is situated around the province—not focused in the GTA—and that, secondly, permits graduates to maintain at the same level we have or at an expanded level.

As has previously been said, right now what limits our capacity to grow is the availability of preceptors: those midwives and graduates who supervise the learners. We do have some self-imposed limits. That's why only a hundred students are taken in across the consortium each year. However, we had just started to address unique ways of expanding this, such as, for example, not recognizing provincial borders for students who are coming from other provinces, because Laurentian really was educating the country, not just Ontario.

As was previously said, all the midwives in New Brunswick graduated from Laurentian. We regularly take in students from the Northwest Territories, from the Yukon and from all across the country, because there were only six schools of midwifery. Now there are five.

[The Chair, Conservative, Marilyn Gladu]

Very good.

Ms. Larouche, you have the floor for six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thanks very much to the three witnesses, Ms. Fulton-Breathat, Ms. Recollet and Ms. Wolfe, for their testimony, and in particular their contribution to midwifery.

I'd like to do what I did when we received the previous group of witnesses. You mentioned the importance of having a university outside of Toronto in northern Ontario. I'd like to mention that because we, the Bloc Québécois, naturally give you our full support. My colleague from La Pointe-de-l'Île has made himself clear on this matter, and has shown his full support for the cause.

The situation is extremely shocking and deplorable. We know that the francophone communities cannot really do without university programs in French. It's therefore absolutely essential to do something. You referred to how important this university was for midwives across Canada, and for the francophonie outside the province, because while this university has a strong presence in Ontario, it also serves people in New Brunswick, the Yukon and elsewhere.

I'd also like to point out that this whole incident is being monitored very closely in Quebec. We already have our own legislation on midwifery services. We have a legal and regulatory framework that is supervised by the Ordre des sages-femmes du Québec.

What do you think about the fact that there is a university in northern Ontario with outreach all over the place, even in Témiscamingue, and that it has to handle the relationship with Ottawa? In Quebec, we already have legislation and an association for midwives.

I'd like to hear your comments on this.

Would you like to begin, Ms. Fulton-Breathat?

[Buffy Fulton-Breathat]

I'm not entirely certain that I'm understanding the question you're asking.

I apologize, but my French isn't very good.

Are you asking how the association is integrated to ensure that French-language services are provided across the province?

[Andréanne Larouche, Bloc, Shefford, QC]

Yes, and I'd also appreciate it if you could speak to us about the extent to which the university is needed to perform such a role. Don't forget that Quebec and the provinces also have a role to play. Many of the aspects involved in midwifery services, such as university education and health, come under provincial jurisdiction.

[Buffy Fulton-Breathat]

At the provincial level, I think the most important thing is to continue to support midwifery practices and their growth and their expansion, because these are the sites that become the areas for learners to refine their skills while they're still undergraduates. That hasn't been an issue. The Ontario government has actually committed to funding every graduate midwife—who then become the future preceptors of our learners.

There is still much of northern Ontario that is not serviced by midwifery. I named about nine practices in northern Ontario, and those are the only nine practices. It's highly limited. There are many communities that are lacking midwifery services right now, so it's essential that we continue to have 100 or more graduates to populate those areas to allow people to be provided services in their first language, in their chosen language, whether or not that is English or French, and that we have a program that allows learners from those communities to be educated in their first language.

[Angela Recollet]

Meegwetch, Buffy, for your remarks.

If I can chime in, Madam Larouche.... Again, I didn't have my translation on, but I caught some of what you were asking.

I do want to share really quickly.... The relationship in Quebec—I guess my question is a rebuttal back to you—is your relationship with the Cree nation. The Cree nation in northern Quebec is a very vibrant community that has taken a very political stance in ensuring that relationships happen, specifically with leadership—in the past with Matthew Coon Come and the hydro dams to ensure that there's revenue-sharing with resources. They've been able to sustain their educational cultural identity, along with their health authorities, to ensure that Cree midwives are happening.

It is not the same as soon as you cross one side of that James Bay border; it's a very different reality. We are now working directly with the Ministry of Health and Long-Term Care, which has been critical, as I was stating in my earlier opening remarks, for the importance of indigenous midwifery in what we now call Ontario. As I was stating, the Shkagamik-Kwe Health Centre is one of two aboriginal health access centres that received specific aboriginal midwifery funding, and the province itself is coming back to expand our program here in the north to ensure that we can continue to recruit and retain aboriginal midwifery.

That is not the case if we lose our midwifery school. Our school is critical to ensuring that we continue to expand this service. Even Sudbury.... It's disgraceful to say that we're in the north. When we talk about the north from an indigenous perspective, we're going into fly-in communities that still don't have access to clean water, so we can't even provide midwifery because they don't even have access to clean water.

[The Chair, Conservative, Marilyn Gladu]

Ms. Wolfe would like to make a comment.

[Naomi Wolfe]

I just want to echo a little bit what Buffy was saying: that communities should be able to access education and care in their languages. You also asked about some accountability structures. I can think of an example where a community midwife from Quebec had strict limitations placed on her ability to open and set up practice because she was not francophone-speaking. However, her community is Algonquin and English-speaking, and nobody in her community would require access in French. Because of the regulations in how midwifery care is delivered in Quebec, there were significant roadblocks and challenges to her being able to set up a practice and provide care in her community.

I would probably imagine that similar things are happening for midwives who are wanting to work in their northern communities and Cree is their first language.