Status of Women Committee on May 6th, 2021

[The Chair, Conservative, Marilyn Gladu]

I call this meeting to order.

Welcome to meeting number 32 of the House of Commons Standing Committee on the Status of Women. Today's meeting is taking place in hybrid format, pursuant to the House order of January 25, 2021, and the proceedings will be made available via the House of Commons website. The webcast shows the person speaking rather than the entire committee.

Today our committee is beginning its study on midwifery services across Canada.

For the benefit of the witnesses, when you want to speak, you can click on the microphone icon to activate your mike, and your comment should be addressed through the chair. Interpretation is available. If you look at the bottom of your screen, you can select the language you prefer. When speaking, please speak slowly and clearly for our interpreters. When you're not speaking, your mike should be on mute.

Now let me welcome our witnesses who are joining us for our first panel. They'll each have five minutes for their opening remarks.

We have Lisa Morgan, who is a registered midwife. We also have Tom Fenske, who is the president of the Laurentian University Staff Union.

Lisa, we'll start with you. You have five minutes.

[Lisa Morgan, Registered Midwife, As an Individual]

Thank you.

My name is Lisa Morgan, and last Friday I was the director of the school of midwifery at Laurentian University. Today, I come to you as Lisa Morgan, registered midwife, after 14 years as tenured professor at Laurentian.

I speak today not as one voice. I also bring the voices of Dr. Kirsty Bourret and Dr. Karen Lawford, who are francophone and indigenous midwives and scholars, as well as a group called SOS, Save Our Sages-Femmes, a group of francophone, indigenous and northern stakeholder midwives who come from across Ontario.

Throughout the world, midwives provide essential, cost-effective, person-centred health care services. Investing in midwifery globally could save 4.3 million lives annually by 2035. In Ontario, midwives deliver nearly 20% of all babies as a regulated, funded and insured health profession. We are autonomous primary care providers, and we're in high demand across Canada and across Ontario. In many instances, midwifery clinics cannot keep up with this demand.

Unfortunately, Laurentian University unilaterally decided to close its school of midwifery, effective April 30, 2021, and all faculty contracts were cancelled. In a communiqué to students on April 12, university president Robert Haché stated that the midwifery program was cut due to low enrolment.

The midwifery program has been full ever since its inception in 1993. This year, there were over 300 applicants for the 30 available seats. We are financially viable because midwifery education programs are envelope-funded by the provincial government, with additional student tuition contributing to overhead.

The school of midwifery at Laurentian University was one of only six midwifery schools in all of Canada—there are only five now—the only francophone midwifery school outside of Quebec, as the Quebec midwifery school does not admit anyone who is not a resident of Quebec, and the only bilingual midwifery school in the country.

We provided focused northern indigenous programming, which attracted indigenous midwifery students from across Canada. Since 1993, over 400 midwives have graduated from Laurentian, and 25% of these midwives are francophone. In fact, 60% of midwives working in northern Ontario are Laurentian graduates, and 60% of these graduates are francophone or provide services in French. As well, 20% of Laurentian's graduates are also members of the National Aboriginal Council of Midwives. This demonstrates a critical contribution to reproductive services in northern Ontario, and that Laurentian was more than meeting its mandate to increase services in northern francophone and indigenous communities.

Closing the program will substantially negatively impact northern Ontario women and birthing people and their families, and it accentuates an already sparse health care human resource environment.

The francophone midwifery program in Ontario is essential to the continuity of a francophone workforce. Francophone midwifery outside Quebec needs to serve the 744,000, or 5%, of the total population of Ontario. Studying exclusively in French is a right in order for the students to achieve linguistic, cultural and social well-being and competency. Receiving services in one's mother tongue is crucial and increases the quality and the safety of the care.

Currently in Ontario, the lack of French services persists, with 50% to 55% of francophones having little or no access to health services in their mother tongue. In addition, the francophone minority intersects with indigenous, black and persons of colour. Francophone visible minorities are mostly clustered in central and eastern Ontario and 16% of francophones identify as visible minorities. As with visible minorities in the general population, they live primarily in central and eastern Ontario.

I'd like to hold up l'Hôpital Montfort in Ottawa as a unique example, with its obligation to maintain the French language, embody French culture, foster solidarity with the Franco-Ontarian minority and protect the Franco-Ontarian community from assimilation. In order to achieve its objectives, it must hire francophone midwives. Of the 25 midwives who maintain privileges at l'Hôpital Montfort, greater than 60% are graduates of Laurentian University's midwifery program.

We do not believe the only locations for midwifery education should be in the universities of southern Ontario. We appreciate that Ryerson and McMaster stepped forward in a crisis and they're doing their best to support our current students, but this can only be short term.

Historically, decisions about the location of the third midwifery school were careful to consider the values of decentralization. There were concerns expressed about two out of the three schools being located within one hour of each other. We are now in a position, 28 years later, of having only these two closely located schools available for midwifery education in Ontario.

Ontario needs a bilingual midwifery education program. It's critical for indigenous, francophone and northern communities. We need more midwives, not fewer.

We are, and will continue to be, the indigenous and francophone midwives of northern Ontario.

[The Chair, Conservative, Marilyn Gladu]

Now we will go to Mr. Fenske.

You have five minutes.

[Tom Fenske, President, Laurentian University Staff Union]

Thank you.

Thank you, Lisa.

Lisa has been doing a great job leading that program.

I don't have a lot of speaking notes. I was heavily involved through the CCAA process as the president of the staff union.

When it comes to midwifery programs, there's a lot of confusion. There are a lot of questions unanswered. You heard from Ms. Morgan that the enrolment has been exactly what it's supposed to be. It has hit its target every year.

What we are very confused about is the actual building of barriers in 2021. We feel like this is a situation where, because of a decision that has been made.... These decisions that were made through this process were about dollars and cents. The functionality of the institution, or the functionality of servicing women in the north, was not part of this discussion, and it should have been.

If you look at some of the midwife programs in the north.... I was lucky enough for two of my children to have midwives, and I was even luckier that I had the same two midwives both times. Xavier was the last baby that one of them, Meghann, delivered. She went up north to work in Timmins. I think it's called the Boreal Midwifery Practice, and both of the people who work there in Timmins are Laurentian graduates, to my knowledge.

If the program wasn't based here in Sudbury at Laurentian University, would there be a practice in Timmins? I don't think there would be. That's the precise reason that having a midwifery program down south is fantastic, but it does not service the north. There is a significant number of indigenous students and francophone students.

You will see that we have an indigenous learning centre. In that centre, there are specific rooms that are designed just with a phone and a booth. That's because indigenous students feel disconnected because they are not in their communities. The idea that you would now ask indigenous students to go to southern Ontario is going to create significant barriers, barriers that were supposed to be, over years, brought down.

When you look at the system, and I'm sure Ms. Morgan would talk much better about it than I would, you see there's a lottery to get into the program. There's a separate lottery specific for francophone and indigenous students. That's about taking down barriers. That's about making sure that people have access to the things they need to have access to in the north. A decision like this in 2021.... I am baffled by the idea that we would be moving away from servicing northern Ontario, which this decision has done.

We've asked several times why this is happening. For other programs they would give us the reasons they made those decisions, but there was nothing they could tell us about the midwifery program. We kept saying this is an envelope of funding. It hits a target every year. It's a good program. It's servicing the north. How is this on the list of programs to be cut? The only real excuse they gave us was that the funding could dry up one day, and then they'd be stuck with people.... They wouldn't be in a CCAA process where, as you know, there are a lot of things you can do. If you exit people out of the institution, there is no severance, or it's caught up in a claims process.

My concern is that they took advantage of a point in time. They ignored northern Ontario by doing so and created a massive barrier for this specific program that really does, if you heard Ms. Morgan, significantly service the north.

[The Chair, Conservative, Marilyn Gladu]

Very good.

[Sonia Sidhu, Liberal, Brampton South, ON]

On a point of order, Madam Chair, the staff did not receive good sound quality. Can you check with the clerk?

[The Chair, Conservative, Marilyn Gladu]

Could the clerk check with the interpreters? Staff are not getting good sound for translation.

Is it good? Okay. We'll continue.

We'll start our first round of questioning with six minutes each, beginning with Ms. Shin.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Thank you, Madam Chair, and thank you to the witnesses today for being here on such quick notice.

The whole topic of midwifery is quite unfamiliar to some people. Having never had children myself, I would love to learn more about it. I understand that it's a very valuable part of the birthing process, and an option that has been available.

How is midwifery regulated in Canada? I would like to understand that.

[Lisa Morgan]

It's done province by province. We have regulatory colleges, and we have the College of Midwives of Ontario that regulates our graduates. We've recently launched a national accreditation program for midwifery schools, so now there is that national oversight around the quality of the program.

The schools in Ontario were visited for accreditation over the last year and a half, and a member of the college of midwives was present, as the regulators want to keep a close eye on accreditation as well. We have a very defined scope of practice. Midwifery exists almost everywhere.

P.E.I. and Yukon are kind of pulling things together and have made recent announcements, so I think that shortly we will have midwifery across Canada.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

That's wonderful. Thank you.

You mentioned, Lisa, that Ontario has 20% of the babies delivered by midwives and that midwives are instrumental in saving many lives. Could you speak to what that looks like?

[Lisa Morgan]

As midwives, we do really good work in serving vulnerable populations, with the time we can take and the way we work with our social networks around us. During my many years of practice, teens were a group that I served well. My practice was Cambridge Midwives, where 15% of our midwives' clientele were Muslim and specifically needed female caregivers. We really tried to reach refugees, immigrants and the hard-to-reach.

We do have the evidence to say that we are doing a good job. We have good outcomes. We have lower intervention rates with equally good outcomes, and we've been found to be cost-effective in the system. Every 28 years in a health care system feels new, but 28 years has allowed us to gather the data that shows we're doing a good job and reaching the people we need to reach.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Could you provide some data? You may have already said it and I missed it, but overall across Canada, how many births annually...? Perhaps you might be able to provide some data for that and also data specific to Ontario.

[Lisa Morgan]

Those are numbers that I'm not prepared with right in front of my hands as I'm sitting here. It's 20% of babies in Ontario. It's not the highest in the country. In B.C., midwives are delivering 25% and have probably exceeded that by now, whereas in provinces with smaller numbers of midwives, of course, that number could be quite a bit lower. I think that nationwide the number is probably at about 12% of babies across Canada delivered into the hands of midwives.

Ontario is where the first midwifery program launched in 1993. Like I said, with us gone, there are only five remaining. When we talk about our ability to deliver babies across Canada or serve the needs of vulnerable populations, it depends on building that workforce. We have a lot of apprenticeship within the degree—two and a half of the four years are spent in clinical practice—and we're one-on-one apprenticing with a midwife to learn our skills through a lot of that time.

The growth of this profession is in the sustained support we need in order to grow the midwifery workforce and to be able to then grow the percentage of babies that midwives are able to deliver. I will comment that 85% of pregnancies are low risk. Reproductive health care in general could be delivered by midwives. In doing only 20%, there's a huge margin that we could be serving. As we know, more and more, family doctors are leaving maternity care or obstetrics, and midwives have been there in the last 28 years to fill that gap.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Thank you so much.

I have another question. How has COVID-19 impacted your clientele?

[Lisa Morgan]

It's made the work of midwifery harder, but it has introduced that choice for people who want choice of birthplace. There are people who did not feel that during this—

[Sonia Sidhu, Liberal, Brampton South, ON]

I have a point of order, Madam Chair.

[The Chair, Conservative, Marilyn Gladu]

Go ahead, Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Chair, the French translation is coming in on the English channel.

[The Chair, Conservative, Marilyn Gladu]

Both are coming at the same time now.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

I wonder if Lisa could start again from the top, because it was speaking in—

[Andréanne Larouche, Bloc, Shefford, QC]

Excuse me, Madam Chair, but I couldn't hear the interpretation at all.

[The Chair, Conservative, Marilyn Gladu]

The translation is not working.

Can the clerk take a look? We'll suspend briefly, and you won't lose your time, Ms. Shin.

We'll pick up with Lisa.

[Lisa Morgan]

The question was on the effect of COVID on midwifery clients. It introduced more choice. We are the only care providers delivering babies at home, and we have the evidence to show that it is a safe choice. It was a choice made by increasing numbers of people as they were giving birth during this pandemic, which brings to light the importance of having an alternate care provider to be able to provide care in a different way under varying conditions.

I will say for the midwives, though, that not being essential workers made the pandemic quite difficult. No PPE was paid for or supplied by the government and they could not afford PPE for our students either, so we had to supply our students with all their PPE for their placements, which added thousands of dollars of cost to our program budgets this last year as well.

[The Chair, Conservative, Marilyn Gladu]

We will go to Ms. Hutchings for six minutes.

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

Thank you to both of the witnesses for being here for this incredible conversation.

I'm from Newfoundland and Labrador, and I think it was 2018 that my province recognized midwifery. I come from a very rural riding, as my colleagues hear me say all the time. We're promoting mental health, telehealth and rural health, but you can't really deliver a baby over the Internet, so the uptake and the interest are incredible.

I have a story. I have a nephew and his wife who live probably two hours from any major hospital, and when she was due—and again she was a safe pregnancy—they had to move into a community where she was able to be closer to a hospital.

How do you think midwifery services contribute to women's mental health throughout their pregnancy and delivery? I know that my niece-in-law was totally stressed that they had to pack up and move and go to a place. They were looking for a midwife in the area where they live, but one wasn't available at that time.

I'd love to have your thoughts on that.