Status of Women Committee on May 10th, 2021

[Alixandra Bacon]

I can speak to a somewhat sad example. In my practice very recently we had an indigenous birth-giver who was pregnant with her fifth child. She had had two previous losses. Her eldest child was severely disabled and in a wheelchair with a feeding tube and required 24-7 care, and she found herself in the very sad circumstance of experiencing another second trimester loss at 18 weeks. It was what we call a “missed miscarriage”. She had to be induced to prevent complications associated with this and it was extremely important to her that she received care that was holistic as well as culturally sensitive.

To provide this care I connected with an indigenous doula to assure my patient that she could have culturally competent support. I looped in spiritual care to better understand her requests. For example, she wanted a cedar wrapping of the baby as part of a ceremonial burial, so we coordinated on that to ensure that it would occur. We connected to make sure that she would have child care so she and her partner could be together for the birth of their child, while their eldest and their other children could be well taken care of, and we helped to facilitate a traditional burial with an elder from her community.

That would be my example.

Kim, would you like to share one?

[Kim Campbell]

I have one that's more uplifting but maybe not as impactful as what you had happen, Alix.

I work in a community birth program in Surrey that serves new Canadians. There's a large immigrant population there and we have access to translation services through the Fraser Health Authority, and we have many people whose first language is not English, or who speak very little English at all. One particular person had come from a French-speaking African nation, and though I didn't speak any French, we were able to get an interpreter for them, and we got a community member who became a doula and provided doula services to them. We did absolutely everything and looked after all of her wishes. She came from a traumatic background. She had come from a country that had experienced war and violence, and she was exceptionally traumatized. She had PTSD and we facilitated a beautiful spontaneous birth because we set the stage for what she needed.

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

Thank you so much. I really love the sense of dignity that you're bringing through these very specialized forms of care.

My question now has to do with COVID-19 and how it has impacted midwives and how it has affected hospital births versus births in the homes of the pregnant mothers.

The question is for both witnesses and maybe we can start with Alix.

[Alixandra Bacon]

Thank you so much for your question.

I think that midwives have really stepped up in the time of COVID-19 to sustain their services and to offer new services, including advocacy for people who are birthing to receive respectful care and the support they need.

To give you an example, at times in the pandemic there were birthing people who were denied the presence of a support person in labour, and midwives advocated to ensure that the birthing people could have the appropriate support, which we know the evidence supports in showing reduced rates of Cesarean birth and other interventions.

In my place of work, people can bring in their partner or they can bring in a certified doula. We are masked, although the birthers aren't necessarily wearing masks when they're pushing. They're not able to bring in their families to visit them afterwards anymore, and extended families are no longer able to be present for the births. There have been, in certain jurisdictions, restrictions on home births that were made very hastily, and I'm very pleased to say that the midwifery leadership advocated strongly for home birth to be reinstated. As I believe Ms. Tecson alluded to earlier, one of the strengths of midwifery during this pandemic has been that we offer care out of hospital which relieves the pressure on acute care settings, as well as keeping healthy people away from sick people in acute-care settings.

Midwives have also expanded their offerings to include COVID testing and COVID immunizations, and to provide care for those who found themselves unattached to their primary care provider, because, at the beginning of the pandemic, many family physicians closed their practices. Midwives didn't have that luxury of waiting to figure things out. We hit the road and ensured that people continued to receive the care they required.

[The Chair, Conservative, Marilyn Gladu]

Very good.

Now we'll go to Ms. Dhillon for six minutes.

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

Thank you very much, Madam Chair.

I'll start with Ms. Bacon. You had a very heartbreaking story about what can sometimes happen. I'd like to ask you about this. Following the closure of the midwifery program at Laurentian University, there will be a disproportionate impact on indigenous students. What are the consequences of a decrease in the number of indigenous midwives across Canada, in your opinion?

[Alixandra Bacon]

We cannot afford to have a decrease in indigenous midwifery. In fact, we need to be focusing all of our investments on growing the workforce of indigenous health care providers to fulfill our...Truth and Reconciliation Commission and the UN Declaration on the Rights of Indigenous Peoples. This will be devastating.

We've seen Joyce Echaquan, and we're hearing the call for Joyce's principle out in British Columbia, where I'm located. We've recently looked at the “In Plain Sight” report. The impact of racism on indigenous families is devastating, and it's unacceptable. We cannot afford to lose any of our indigenous midwifery practitioners. In fact, at this time we need to be funding and innovating so that we can increase the number of indigenous midwives available to provide culturally safe care where and when it's needed.

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

Thank you very much.

Ms. Campbell, would you like to add something to that.

[Kim Campbell]

I agree with Alix. There are so many examples I can recount where my lack of understanding and knowledge of their culture and their community has had such a detrimental effect, I think, in not being able to meet their needs. That's not just indigenous people, but many people. I think we need to increase diversity in all areas. With regard to indigenous...absolutely, I hands down agree with Alix.

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

Thank you.

Ms. Campbell, how many bilingual midwifery programs are offered in Canada, and what is the number of student applicants in comparison with the space offered for these programs?

[Kim Campbell]

Right now there's only one program in Canada that offers French-language instruction, and you have to be a resident of Quebec to attend it. It's at the University of Quebec at Trois-Rivières—it's Sherbrooke, rather. It's limited to people who live in that province, so with the closure of Laurentian, there is no other francophone instruction available.

The second part of your question was...?

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

What number of spaces are available to those who are applying to these positions?

[Kim Campbell]

They have 24 seats a year at UQTR that they admit to, and they would all be French-speaking people. Those would be the only seats available in Canada for French-language instruction for those people living in Quebec.

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

So you believe there is a serious need for more spaces and more....

[Kim Campbell]

Yes, but we have a bit of a dilemma right now.

Alix spoke a bit about the burnout that midwives are experiencing. COVID has certainly contributed to that, but lack of pay equity and resources have also had a significant impact on the workload that midwives have been experiencing.

You need preceptors to train midwives. I mentioned that there are 2,500 hours of clinical time spent in the midwifery program, where students are placed with midwife providers to learn how to practise, just like medicine and nursing does.

When we burn out midwives, they're not able to find the energy and the time to teach. We've experienced a significant drop in our preceptors in B.C., and I know that has been felt in Ontario, in Alberta, and it's been reported in Quebec. We have significant issues with preceptor burnout.

We need more midwives. However, the University of British Columbia was offered an expansion to our program, and we had to say we could not at this time bring more students in because we couldn't place them.

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

My God.

Ms. Bacon, I have a question for you.

You've done considerable work in sexual health education. Can you share with us how midwifery services support the provision of sexual and reproductive health care in Canada?

[Alixandra Bacon]

Thank you so much.

This is an area where midwifery is greatly underutilized, as Dr. Bourret alluded to earlier.

It is within the scope of a midwife to provide cervical cancer screening, to be providing contraception, including the placement of intrauterine devices and the new Implanon contraceptive insert. It's in our scope of practice to be testing and treating for sexually transmitted and blood-borne infections.

However, in some jurisdictions, this is with an advanced scope of training. It is not accepted in all jurisdictions. There are also constraints, in that we are limited to providing this care, in most cases, though not all, to people who are pregnant or in the first three months postpartum.

This is an area where midwives could be providing a much larger role and having a bigger impact in helping to meet that unmet need for contraception in Canada, for long-acting, reversible contraception in particular, and that culturally safe component of care.

There are pilot projects, in Ontario in particular, such as the MATCH program, where midwives are working with delegation of function to be able to provide these services to people outside of that child-bearing year, as well as to provide abortion services. These are areas where we can expand.

[The Chair, Conservative, Marilyn Gladu]

Thank you very much. Your time is up.

We will go to Ms. Larouche.

Ms. Larouche, go ahead for six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

I thank Ms. Campbell and Ms. Bacon for joining us today and for reminding us of how important of a role midwives play in women's reproductive health. They are also reminding us of the important role of the program that has been abolished at Laurentian University for francophone communities in Canada, indigenous communities and northern communities.

You explained that those communities must be served in their language, that they have unique needs and that the program was important to them.

Ms. Bacon, you also talked about inequitable pay, health system underfunding or an unfair service allocation. You also talked about the importance of investing more in midwife associations.

Ms. Campbell, you talked about the fact that midwives were underpaid, and you also talked about income inequality and the lack of resources.

At a time when the pandemic has exacerbated problems, midwives and health care staff are exhausted. It is important for the government to reinvest in health transfers to enable Quebec and the provinces to in turn reinvest in their health system. That would obviously impact midwives.

I would like you to talk to us about the importance of having a vision now. We should not wait until after the crisis to give money back to the health system and to provide means to help midwives and other underpaid professions.

As you have both discussed the issue of funding, perhaps Ms. Campbell could start. We will then hear from Ms. Bacon.

[Kim Campbell]

There are several initiatives that could be undertaken if the scope of practice were enhanced to help make better use of the funding we have. Right now we have siloed health care systems, and midwives who have capacity to provide a more comprehensive service could be bulked into a team delivery system, for example, so that funds would.... Actually, you may not have to find more money. You could just be more creative in the use of the monies you have. However, right now we have a bit of a double-dipping system, and we have to refer to other providers to duplicate care when we actually have the competency and the skills to do it. That costs consumers money.

I think if there were midwives in leadership positions, they could potentially bring their lens to the discussion, but we can't even, at this time, be at the table for some of these discussions because we're not recognized.

[Alixandra Bacon]

I'd like to build on what Kim had to say. It is important not only to fairly compensate midwives, but also to integrate midwifery into the health care system. Otherwise, we will see situations like we see in some of the provinces and territories that are using the employment model, where there's complete stagnation in growth. We are asking impossible things of the provinces and territories where there are four midwives. Those midwives are expected to practise clinically and represent midwifery in regulation, in associations, at all of the committees and in research. It's an unacceptable burden to put on a small group of health care providers.

The Canadian Association of Midwives has identified, as one of our three key pillars, focusing our efforts on strengthening midwifery professional associations. We've had huge success with this and being able to impact the health rights and well-being of women and girls in our association-strengthening work abroad. However, we do not currently have the funding to provide those same supports to see that midwifery is integrated and midwives are put in positions of leadership here at home in Canada. We would like to see a partnership that provides midwifery capacity building to associations in the provinces and territories and to the National Aboriginal Council of Midwives so we can do the capacity building and create a more sustainable system.

[Andréanne Larouche, Bloc, Shefford, QC]

Exactly.

I want to come back to the Laurentian University Midwifery Education Program and to its importance in improving the recognition of that profession and in ensuring succession for midwives in francophone and indigenous communities.

Ms. Campbell, could you tell us some more about the importance of the program and about the connection between succession and the recognition of the profession?

[Kim Campbell]

Perhaps the best way to deliver an education program that reduces barriers for participation is to distribute it to the communities. We're trying it in British Columbia. We're distributing programs to the communities so that students are coming together as a cohort to learn over small periods of time. Then they're going back to their home communities, or to communities close to where they normally live, to continue their education there.

We know that when we educate people in their communities they stay in their communities, and that when we bring people to the south, they sometimes don't go back, or they can't succeed in the program because they have lost the support of their family. We had an indigenous student come into our program many years ago who experienced so much trauma and grief from the effects of social determinants of health that it was too overwhelming for her to stay. Had we been able to be more flexible in our program and offer something that was more unique to meet her needs, there would have been a different outcome. I think there are so many different things we could be doing better.

[The Chair, Conservative, Marilyn Gladu]

Now we'll go to Ms. Mathyssen for six minutes.

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

Thank you so much.

You both spoke about specific stories that you had heard or that you had seen directly from a lot of your clients. When we talk about “vulnerable populations”, there is so much that could mean. I think a lot of women using a midwife do so for religious or cultural purposes. They don't have trust in the system and don't want to enter an institution like a hospital.

Obviously when midwives enter a home, there's a very different type of service. Can you talk about the importance of them for a group or culture impacted by an institutional reality that doesn't fit with what they need for birthing?