Status of Women Committee on May 10th, 2021

[Kim Campbell]

Can I go first, Alix?

I'll take that on. I serve a population in the Fraser Valley that holds deep religious beliefs, one of which involves the non-interventional approach. They choose to birth at home and, because of their strong beliefs, won't accept any interventions that others would consider life-saving.

Through our embarking on relationships with some of the people in that community, they have come to trust us as listening to them and supporting them and advocating for them at every turn and asking them what we can do for them to help them meet their life goals. It's always an honour to be asked into someone's home to support them at the most intimate time of their lives. It's very important that we continue to do that, so offering home birth services and offering people care where they want it and when they need it is integral to an informed choice and a culturally sensitive care model.

[Alixandra Bacon]

Thank you, Kim.

I think there's enormous benefit to the continuity-of-care model that midwives have as well as to our fee structure. The continuity means that we're working in small groups. Care is provided by anywhere from one to four midwives in most cases, although there are some very innovative group and collaborative practices. This means we really have a chance to build the relationship and build trust with our clients. The person you meet antenatally is the person who will be present at your birth. There are no strangers. That's very important to people, particularly when we are providing trauma-informed care.

I can think of examples. I care for many Muslim birthers in my community. It's very important to them that there be no men involved in their care, and in a home birth situation, we can control the environment and ensure that they are receiving care from an all-female team, for example, if that's important to them.

In the case of queer families, I've provided home birth for queer families in which one of the parents is transgender and is very concerned about the discrimination they might face during a birth in the hospital. A home birth has been a way to provide them with safe and respectful care in which the correct pronouns are used and the family can really celebrate the birth without having to defend their human rights.

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

Thank you.

Basically what we're talking about in terms of that institutionalization of medicine, the colonialization of medicine as we know it and as maybe someone like me would feel more comfortable with is that it certainly doesn't cover what's required.

Ms. Bacon, you said that a lot of the services you provide are not accepted in all jurisdictions. That speaks to that institutionalization. Can you maybe expand on what you meant by that?

[Alixandra Bacon]

I think that while we do have Canadian midwifery competencies that are standardized and we do write a national exam, you do see small variations from jurisdiction to jurisdiction in the scope of practice, and those relate somewhat to regulations. Depending on the body involved in setting the midwifery regulations, there can certainly be politics and, I would say, gender discrimination and maybe some territorialism that's at play in determining who gets to provide what services.

The great irony is that we have Canadians who have unmet needs for sexual and reproductive health care, whether that's trans-inclusive care or access to long-acting reversible contraception or terminations, and yet at the same time due to the somewhat siloed nature of care, we have conversations about protectionism and about how one health care provider cannot steal a piece of the pie from another health care provider.

I think it's very important that we're breaking down silos and that we're providing care that's really family-centred care and based on the needs of the individuals receiving it. If we focus on that shared goal of meeting those needs, I believe we'll come to better solutions.

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

I know you're going to cut me off, Madam Chair, so I'll give you the rest of my time.

[The Chair, Conservative, Marilyn Gladu]

Oh, how wonderful.

We'll go to Ms. Sahota, for five minutes.

[Jag Sahota, Conservative, Calgary Skyview, AB]

Thank you, Madam Chair.

I'd like to thank the witnesses for being here today.

My colleague Ms. Shin asked you about how COVID has impacted the practice of midwifery and whether there's been a change in the number of births since the pandemic happened.

Ms. Bacon, you answered that. I'm just wondering if Ms. Campbell has anything to add to that.

[Kim Campbell]

I mentioned that it's also been exhausting for our teachers. The midwives are so consumed with the extra work that goes into keeping safe: maintaining their safety and ensuring the safety of the people they're caring for and the colleagues they work with and their families. There are midwives who aren't living at home because they feel it's unsafe to come into their home environment. They're living in a segregated space so they can keep their families safe. It's just too much to take a student into, so the impact of COVID on the education program has been devastating.

We have concerns right now—I guess I can say this—about the ability to provide enough placements for our second-year students at the University of British Columbia. Right now, we're reconfiguring the way we're delivering our programs so that we can meet the learning objectives, but we're being very creative in how we do it. This is the first time that we've had to do something like this.

[Jag Sahota, Conservative, Calgary Skyview, AB]

Thank you.

Did you have anything to add, Ms. Bacon?

[Alixandra Bacon]

I did want to add to and build on that to say that the Midwives Association of B.C. has been conducting research on burnout in their population. They found that, over COVID, the proportion of B.C. midwives who reported moderate to high work-related burnout has increased from 45% in 2017 to 77%. That has resulted in the proportion of midwives who've made plans to leave the profession: It more than doubled in the same time period. Twenty per cent of midwives in British Columbia now are considering taking steps to leave the profession.

[Kim Campbell]

Can I add something to that?

[Jag Sahota, Conservative, Calgary Skyview, AB]

Go ahead.

[Kim Campbell]

There are 25 vacancy calls in Fraser Health for midwifery positions, and that has never happened—ever. We've lost 25 midwives in one community where there were 100.

[Jag Sahota, Conservative, Calgary Skyview, AB]

You both spoke about this, but I think it was more Ms. Bacon who spoke about the C-sections and hospitalization admissions being low when there are midwives involved. What are some of the contributing factors for that ? That's actually quite interesting.

[Alixandra Bacon]

Kim, do you want to take this one first. I know it's your wheelhouse.

[Kim Campbell]

You bet. It is my wheelhouse. That's the evidence-informed practice for midwifery care.

We have evidence that supports the fact that the role of the midwife contributes to several decreases in interventions, caesarean sections being one of them. We think it's the continuity of care. We think it's the relationships we build and the trust and the comfort that people have when they're with someone they know. It's quite simple: It lets their body do the work. Anxiety stops that, so when you create a soft landing spot and a safe place for people, the body does what it needs to do. It's very simple. That's it.

[Alixandra Bacon]

I would add that midwives picture birth as a normal life event. We do not pathologize birth. Also, we've learned the art of watchful waiting.

There's the cliché of midwives knitting in the corner, but it's for a very good reason. If we're knitting, we're not intervening needlessly. I think that's a real unique midwifery skill set that contributes to the decreased caesarean rates, as well as the time with our clients to make sure they're really well informed and prepared for what to expect in a birthing process.

Also, they have that continuous support in labour. We don't just sweep in at the end and catch a baby. We are with them from the onset of active labour until an hour or two after they birth, and that means that sometimes I might spend 14 hours straight with someone in supporting them. I believe it's that quality time that we spend one-on-one that makes the difference.

[Jag Sahota, Conservative, Calgary Skyview, AB]

You've just said that you can spend up to 14 hours with someone. Do you come up with specific solutions for the clients depending on their needs and accommodate them? Let's say they're a high-risk client. Does the care start earlier than it does for others and end later as well? How is that managed?

[Kim Campbell]

I can jump in a bit here.

We have a system of risk assessment and we make sure that we individualize the care to meet the risk and the needs of the person. We always have our antennae up. We're always checking the environment. We're always situationally aware, and we pivot constantly.

[The Chair, Conservative, Marilyn Gladu]

Very good.

Now we'll go to Ms. Sidhu for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair.

Thank you to all the witnesses for being with us, and thank you for your testimony.

My question is for Ms. Campbell.

What is presently being done to support the retention of midwives across Canada?

[Kim Campbell]

Thank you very much for the opportunity to answer that. The answer is, not enough. We have an exodus of midwives, a hemorrhage of midwives from the profession.

We're trying to negotiate system changes. We have very little flexibility in how midwives can work. Some of the working teams are requiring midwives to do team model care, call care. There's no way to use your competency and skills if you can't get up in the middle of the night, or you have a chronic care family member you have to look after or you have some unique issue with your health. There are sometimes no half-time positions for midwives to take. Depending on how the model is funded, the overhead can be crippling.

It's not sustainable in many of the places in the country as it's run right now. We have significant issues.

[Sonia Sidhu, Liberal, Brampton South, ON]

How do you think the two levels of government can better collaborate when it comes to the midwifery program? Do you have examples from other federated countries?

I would ask both of you to speak on that.

[Kim Campbell]

Alix, maybe you can speak to that with your ICM focus right now.

[Alixandra Bacon]

Absolutely.

I think it's critical that we see a national federal-level midwifery office, with a chief midwifery officer, whose role it would be to liaise with the ministers of health, advanced education—education federally and across the provinces and territories—to facilitate these sorts of conversations.