Status of Women Committee on May 6th, 2021

[Lisa Morgan]

Certainly that is our dream. That's what the Canadian Association of Midwives would say: a midwife in every community. We know we're most successful when we train people from the community to return to the community and when we remove people from community for as little time as possible, when clinical training can be done within the community that person plans to serve.

You mentioned one aspect, having that caregiver close by for checkups, visits or support, but it's also for the connections. It's called continuity of care when you develop a relationship with the person you're caring for. We are on a pager 24-7, and those calls, those mental health concerns, those check-ins that you can do with your midwife if you're not well.... We pay really particular attention postpartum. We care for the mother-baby diet until six weeks postpartum. We're talking to the family about postpartum depression. We're talking to that person about reaching out to us and about the supports that we can help with.

We also know that some of that mental health stuff around pregnancy and postpartum is around emergencies, processing and lack of information, so we really try to do a good job with debriefing the birth, why what happened happened and what questions we could answer. We also know that goes a long way in terms of reconciling what happened and what needed to happen, because we have the evidence to say that good births are not really about that unmedicated normal vaginal birth that goes straightforward. It's about that person feeling involved in the decision-making. There are good Caesarian sections. You just have to understand the reasons, have your questions answered and have that relationship and that trust.

When we talk about mental health, I think that goes a long way.

[Gudie Hutchings, Liberal, Long Range Mountains, NL]

Tom, I'm just going to ask a quick question of you.

There was a great article in Maclean's in October of last year saying that midwifery is in demand, but increasing school program capacity isn't easy.

How can we best support and advocate for the midwifery programs moving forward?

[Tom Fenske]

I think there should be full recognition of the value they bring. Maybe I'll give you a personal story. When my eldest, Madeline, was born we had family members who were a little skeptical. They were not as comfortable with midwives, and we were figuring it out because it was our first child. That skepticism melted away when the midwife, I think it was Nicole, came to our house and sat on the bed and spent an hour debriefing us—here is what you need to do—and answered all our questions. At the time my mother-in-law was in the house and there was complete confusion around the idea that the midwife would come to the house and that we would see her again in two days, that she was coming back.

That kind of knowledge and that intimate relationship that is built, getting that information out there and helping people understand, it's such a.... The whole experience involved.... They used to host an annual party before COVID and everyone would show up. You would see all these families and all their children running around Fielding park. That advocacy of helping is the whole story of the midwifery program and what midwives can bring, and using the people who do it is probably the best way of approaching it.

[Gudie Hutchings, Liberal, Long Range Mountains, NL]

Thank you. We need to move beyond just having a pamphlet in a doctor's office and do some work and support in that area.

I think I have a little time left, Madam Chair.

Lisa, what are the challenges facing midwives today? We just touched on one—the acceptance of a generation, we'll say. I know my mother would have said the same thing, if I had wanted to. I looked at it but I did hypnotherapy, because there wasn't a midwife around.

What are the main challenges and what recommendations do you have to help address those challenges?

[Lisa Morgan]

Burnout is probably the biggest challenge, and we're seeing that now. A recent study said two-thirds of B.C. midwives were considering leaving. There was some participation of Ontario midwives, but burnout is certainly an issue.

There has been austerity in the health care system as long as midwifery has been around. There was a hard fight through the Human Rights Tribunal for Ontario midwives to achieve pay equity, and we are in appeal again still. Other pressures like paying for PPE or not being considered essential certainly contribute to the burnout.

[The Chair, Conservative, Marilyn Gladu]

That's your time on that question.

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

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

I'd like to begin by thanking the two witnesses for having come to testify before the committee this morning. They've shown us why midwives are important.

On behalf of the Bloc Québécois, I'd like to express our solidarity with northern Ontario francophones. Our political party unanimously adopted a motion expressing the House of Commons' concern over the crisis that has shaken the world of Franco-Ontarian post-secondary education. I'll read the motion:

That the House express its concern about the closure of 28 French language programs and the layoff of some 100 professors at Laurentian University in Sudbury;

That it reiterates its solidarity with the Franco-Ontarian community; and

That it recalls the essential role of higher education in French for the vitality of the Franco-Canadian and Acadian communities.

It's an important motion, introduced in the House by the member for La Pointe-de-l'Île.

It's a shocking situation. I'd like to hear what the two witnesses have to say about this, and about how the Laurentian University crisis and the status of the midwifery program are linked.

I'll ask Mr. Fenske to begin, and then Ms. Morgan could continue afterwards.

[Tom Fenske]

Yes, if I understand the question correctly, it's the barriers that have been created. To have people from northern Ontario have to go to southern Ontario to learn these programs.... That's the whole reason we have a medical school in the north. It's to service the north, to branch out and stay in the north. For a lot of people, where they do their schooling and where they practise and do their internship is where they are going to stay. Our concern is that there is this barrier that was taken down years ago, and that barrier is being recreated. I feel that would be the biggest impact, if I understood the question correctly.

[Andréanne Larouche, Bloc, Shefford, QC]

Exactly, Mr. Fenske. I understand that it was a significant barrier, and linked to what we are discussing today.

Ms. Morgan, you spoke about the impact of austerity in the health care field and about the importance of reinvesting in health systems in Quebec and the other provinces in order to avoid the need for austerity measures and difficult choices. You mentioned just how crucial it was for the federal government to send a clear and strong message about the fact that our health care system needs help, particularly to get us through the crisis.

You both spoke about some of the problems encountered with personal protective equipment during the COVID-19 crisis that led to additional expenses. You raised the importance of increasing health transfers. The Bloc Québécois' position on this is clear. Transfers should increase to 35%. After all, the federal government contributed as much as 50% to health care systems in the past, and then gradually reduced the transfers to 22%, forcing the governments of Quebec and the other provinces to make difficult choices, which are being felt even today, particularly for midwives.

[Lisa Morgan]

I think there needs to be recognition that it takes money to grow a program. To grow a health cadre—to bring back a workforce that was eliminated for 100 years—is going to take investment and it's going to take more than four years or any change in parties. Twenty-eight years, as I said, is kind of a short period in terms of the health profession. We need continued commitment to investing in the growth of this profession so that we have people to deliver the babies who need to be delivered.

In addition to Tom's comments, I want to make an example of this year's list. We admit 30 students a year. We couldn't admit our students to our program this year, but Ryerson and McMaster agreed to admit the 30 students on Laurentian's behalf. Fifteen students will be going to Ryerson and 15 will be going to McMaster.

We did our selections for our offer list the same way we always do. We're mandated to look at indigenous, francophone and northern applicants first. Last year, 60% of our applicants came from this list of people. This year, I'm proud to say, 70% of the successful applicants to our program are indigenous, northern and francophone—21 out of 30. Ten of those successful applicants were francophone.

Since they only have a choice between McMaster and Ryerson, neither of which will be teaching the program in French, those 10 francophone applicants have to be contacted to find out if they are able to study in English. If they cannot study in English at a university level, they'll have to turn down the offer for the midwifery program.

When you say “long term”, this is already starting. This September, we're going to be training fewer francophone midwives. We also don't know whether our indigenous and northern applicants will be choosing McMaster or Ryerson. I do wonder how many of these students, from the 70% on our offer list, will actually end up registered at Ryerson or McMaster.

[The Chair, Conservative, Marilyn Gladu]

We'll now go to Ms. Mathyssen for six minutes.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Madam Chair, and thank you to the witnesses.

You had actually just been talking about equality of official language access in terms of services.

As a member of Parliament, I've come back to studying French. Trying to convey something in a conversation about anything is always a struggle. I think, Tom, you also mentioned this.

Can we briefly talk about how important this is in terms of Canada being a bilingual nation and the rights involved in having access to health services for women? Can we talk about the importance of women having access to these services in their first language, especially at a time when they are stressed out and have difficult questions to ask?

[Tom Fenske]

I can start but I'm sure Ms. Morgan will have a lot more to say than I will.

We have a university in northern Ontario and we have an indigenous learning centre so that people can feel comfortable. They have to feel comfortable and there is a trust component. When you can speak in the language of your choice, your trust level is a lot higher. If you and the person you are dealing with are able to communicate with each other, you can learn. You're immersing yourself.

A lot of times it's a new city but you're still getting some sense of your home community. You have to transfer it over. If you're going to southern Ontario and there's no francophone program, you're going to be outside the realm of what you know, what you've grown up with and what you've gone to school with.

What's frustrating to me is when the university talks about seeing if they can transfer students into different programs. Well, you know, students don't go to school to be midwives and then be transferred into nursing. They want to be midwives. Now those barriers have been created—you've heard this, Ms. Morgan—so they have to make a choice. That choice is about not training in the language of their choice versus wanting to be a midwife. That's a horrible choice to have to make.

[Lisa Morgan]

I'll add a fine point to my answer, and that is imagining someone in labour.

Take me, for example. I can speak French fairly well, but not when I'm sick.

If we put that woman in labour, what can we even compare that to? Then to be expected to receive services in a second language and communicate in a second language.... Also, there are the choices throughout pregnancy and postpartum, choices about the infant. Very complicated discussions have to ensue to make those informed choices, and to expect that in someone's second language....

The other thing I want to add on to this is that it's not just a francophone issue but also indigenous. There's the ceremony around birth, and this is so community-dependent. It's so important that we train midwives from those communities to serve those communities, and they can only learn to serve those communities in those communities. I think it puts an even finer point on how important that relationship is and that congruency is.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Thank you. That's very important.

There have been a lot of conversations and there's a lot of confusion around what's going to happen next. I know that students and staff are both lost in that and are not really sure where they're going.

You mentioned that the university came forward and that the president said that they cut the midwifery program because there wasn't enough funding. However, we know that's not true because there is envelope funding from the province. Your tri-council comes together and ensures that the program is going forward collectively together and that the envelope funding is taken care of.

They also said that there wasn't enough enrolment, and we know that that's not true as well.

Also, going forward, the province said that it was going to save this program and that there will be a northern midwifery program, except it said only temporarily. The minister made this grand announcement, but when it got back to the actual ministry officials, they said that there were strings attached.

Can you talk about that, the impact that's had and where you're sort of left in all of that confusion?

[Lisa Morgan]

As a terminated faculty member and ex-director of the school, I have no role. I'm unemployed with no severance. I'm not connected. How do I have any say on where a third school would be or on anything about midwifery at this point?

I'm sorry. I kind of lost your question a little bit there. What was the question? It was about weighing in on this announcement.

Midwifery is a very small world. There aren't unemployed midwifery faculty. We all have jobs, except for the ones who were just recently let go from the school. Who is setting up a school and where? Who are they talking to? If they're not consulting with me or my faculty, I'm not sure who they're talking to. I have no details on that at all, and I was the director of the northern francophone and indigenous school of midwifery. If there are any decisions or any conversations being had, I am not privy to them, nor do I know anybody who is.

[The Chair, Conservative, Marilyn Gladu]

All right.

We'll go now to Ms. Wong for five minutes.

[Alice Wong, Conservative, Richmond Centre, BC]

Thank you, Madam Chair.

I thank both witnesses for appearing today to brief us and educate us about the importance of a midwifery service in our nation.

During my time.... You know, I've never given birth to any children. In Asia when I was born, actually, midwives were very important. I was delivered by a midwife. That is why I have fond.... Well, I don't have fond memories because I was then a baby, but my mom used to praise the midwife for helping to have a healthy girl born to the family, so that was important in Asia in those days.

That probably leads to my next question. I think the professor did mention the importance of her students' service to cultural groups. Can you expand on that?

[Lisa Morgan]

It touched a bit on indigenous or francophone—from language to spiritual—but we also know there is a recognition part as well.

We have been engaging in our anti-racism work, looking at our school itself and at our graduates, and recognizing that we need Black midwives, midwives of colour. There is that recognition of what you can grow up to be, as a Black girl, when you see a Black midwife. There is also that connection to the racism that is in our health care system and that understanding and advocacy.

Like I said, there are vulnerabilities on so many levels and they're intersecting, as we all know, so training midwives who are able to best serve the communities where they work is overall what we're talking about.

Midwifery is in a transition phase right now. We are looking at our very white profession and understanding that we are not in the best position to care for all the people who need to access our services, so we're pushing even harder.

Laurentian has had this mandate, always—northern, francophone and indigenous—and it's expanding that mandate to Black and persons of colour. Inclusivity is really where we're at right now in health care.

[Alice Wong, Conservative, Richmond Centre, BC]

Thank you very much.

You said just that you don't have a voice anymore because you are no longer counted as faculty.

That leaves the question to Tom, who is now the president of the faculty union.

I have a fond memory of my own union, when I was faculty at the university college and then a polytechnic university in B.C. I definitely know the importance of the union. Now they are the voice to speak for and represent retired members or members of the faculty.

Tom, can you expand more on the importance of your role in bringing the voice of the faculty to the university?

In B.C., for example, very often when the ESL program is cut or whatever, it is because of funding. This time, it's not because of funding. Can you expand more on that and what you see is the challenge here?

[Tom Fenske]

I would just clarify that I am the president of the staff union. However, I feel it would be the same for the faculty unit. I hesitate to speak on their behalf, but I would say that it is complete confusion.

Arguments can be made for different programs—and I don't think that's something we would want to get into—but with regard to this program, it does not make sense. You have a program that can successfully recruit. It's funded with an envelope. It's needed in the communities that it serves. It's everything you should be looking for at a university. It's checking all of the boxes.

It's not a program where you're concerned about the funding. It's only growing. It's growing in Canada, in Ontario. We're left with complete confusion as to why this happened.

I know that if the university came to our union, or if they came to LUFA, the faculty union, I am sure there could be significant conversations to have that program remain here. However, that's not happened.

[The Chair, Conservative, Marilyn Gladu]

Now we're going to go to Ms. Dhillon for five minutes.

[Anju Dhillon, Liberal, Dorval—Lachine—LaSalle, QC]

I believe my colleague, Mr. Serré, will be taking my place.

[Marc Serré, Liberal, Nickel Belt, ON]

I'd like to thank our two witnesses.

My questions will be for Ms. Morgan. If I have any time remaining, I'll get back afterwards to the midwifery program.

I'd like to thank you, Mr. Fenske, for the work you have been doing. These are difficult times. People have been calling what happened on April 12, "Black Monday at Laurentian University". The situation is affecting the community and the university.

It was a bombshell. No one expected this and this is wrong.

I am going to focus on Ms. Morgan.

Thank you so much. I want to get a bit of an explanation. The midwifery program was set up—the tri-council of McMaster, Ryerson and Laurentian—about 28 or 30 years ago, and the intent was to focus on rural, indigenous and, obviously, the francophone aspect. Now we've completely blown that up. We're sending students back to southern Ontario, where Ryerson and McMaster are one hour apart. It doesn't make any sense. I want you to explain a bit about that.

Also, I read somewhere that Laurentian had an additional cost for the bilingual program of around $200,000 or so. From your experience, can you confirm what the additional cost was to Laurentian? Was the split in revenue one-third to each institution? Was Laurentian receiving any additional dollars for the francophone, indigenous and rural aspects?

[Lisa Morgan]

I think the financial aspect is really important to address. The envelope was equally split three ways between Laurentian, McMaster and Ryerson, but only Laurentian was required to offer the program in two languages with that very same amount of money.

We recently made a request about a month ago to MCU that we needed an increase in funding at all three sites, but Laurentian particularly needed some additional funding to be able to offer the second language. Our translation costs are about $20,000 a year and our faculty costs for teaching in all four years of the degree adds up to $200,000, so I was making a request for an extra $220,000 to fund being able to offer the program in two languages.

It also points to the disadvantages Laurentian has had for so many years, with the expectation that it be delivered in two languages for the very same money as delivering it in one language. We could not ever get any traction that this wasn't fair and there should be more consideration given. Every single course had two streams, a French stream and an English stream. There was a doubling up right through it for no extra money, but we did it. As I mentioned, all our salaries are covered by our envelope entirely.

In terms of the only two schools, I think I said it in my remarks, there are just two schools less than an hour apart training midwives for all of Ontario. In our classrooms, our courses, we put a real focus on rural, remote and northern in everything we did. They will be receiving the same urban midwifery education as any other student at McMaster and Ryerson, without that special aspect on the teaching.