Status of Women Committee on May 25th, 2021

[Louise Aerts]

Sure. I'll start with the positive. I think the COVID-19 pandemic has forced us, across the board, to think outside the box, and in some ways jurisdictions have looked to midwives to solve some of the issues that have come forward. In some cases, they have expanded the scope of midwives. Midwifery is quite unique in that it is defined in terms of the restricted activities as services provided to a pregnant person or someone in the postpartum period. Midwives have lots of skills, knowledge, education and judgment that fall outside that period as well.

One example is being able to test for COVID. Midwives within the regulation could do that for their pregnant clients but not for the general public, so health orders were expanding those services. Similarly, for administering the vaccines, midwives could do so for their clients but not necessarily for the full public. Therefore, midwives were looked to and scope was expanded through temporary orders to allow midwives to fill those gaps. Because they are in rural and remote areas and they have that knowledge, skill and judgment already, it was a natural extension, which has been positive.

On the negative side, and very much in terms of the burnout piece, some of the existing structures that were in place for others around personal protective equipment didn't fall into place for midwives right away, especially in the home birth setting. Everyone knows there was very limited PPE available across the country, but what there was, was in the hospital setting. Midwives weren't able to immediately access PPE for home birth, and they really had to again think outside the box to be able to provide care in a safe way.

I think there is a general burnout. We have seen increases in home births through the pandemic, as people looked to avoid being in the hospital setting. There was a lot on midwives to manage. Often there are very few midwives available in small communities, so to have someone need to isolate or come into contact with COVID-19 was very impactful on those communities.

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

Thank you for your answer.

Claire, the NACM produced a community readiness guide. It was to support indigenous communities as they re-establish and grow their community-based midwifery services.

Can you tell us a few things about the guide? How was it developed and how has it been received throughout your communities?

[Claire Dion Fletcher]

Yes. Thank you.

It was developed from the work that NACM has been doing over a number of years in reaching out to communities, talking about bringing birth back and discussing what midwifery could look like in our communities.

One of the things about indigenous midwifery is that when you look across the country at all the different ways indigenous midwifery looks, you see a lot of variety. From the midwives who practise in Nunavik to the midwives who practise at Six Nations to indigenous midwives out in B.C., how we practise looks different.

[The Chair, Conservative, Marilyn Gladu]

I think she's frozen. We'll just pause here.

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

I hear her just fine, Madam Chair.

[Claire Dion Fletcher]

I'll keep going, Madam Chair.

It looks different because indigenous midwifery comes from within the needs of our communities. We always start with our community, the birthing person and the birthing family. Then we think about what those people need. What is it that our communities need to have better access to health care, to have culturally based and safe care? What is it they want from their birth, and from their sexual and reproductive care? That's how we start.

That's what the community readiness guide helps to do. It talks to the community about going through those processes of thinking about what midwifery would look like in your community.

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

Wonderful. Thank you for that.

Ms. Giroux, why do you think Quebec falls behind the national average in births that have been delivered by midwives?

I think it was May 5 when you called on the Government of Quebec to recognize the place and effectiveness of midwifery services and to look for solutions. Do you think that's the crux of the issue of why midwifery is not used as much in Quebec?

[Josyane Giroux]

Thank you for the question.

As I said earlier, the reasons are quite varied. The main reason there hasn't been a clear plan is that there is no recognition of the profession. Midwives aren't recognized for their work or their importance in the health care system as front-line professionals.

There is a significant lack of awareness of our work among the public and government bodies. There is still a lot of work to be done in this respect. There has never been a campaign or project to address this issue. Every time new services are introduced in the regions, everything has to be redone. This simple awareness work, which must be done on a daily basis, requires a great deal of time and energy from professional midwives.

All of this obviously has consequences and slows down, among other things, the development of the profession. There are a number of things that come into play, but I think essentially, as I mentioned, this is the one thing that needs to be improved.

[The Chair, Conservative, Marilyn Gladu]

Thank you.

Ms. Larouche, you have six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

I'd like to thank the witnesses, Ms. Dion Fletcher, Ms. Aerts, Ms. Murphy and Ms. Giroux, for being with us today. It's always interesting to hear the reality of midwives on the ground.

I'd like to start by going back to what Ms. Aerts said, which is that the pandemic revealed that this profession had experienced a certain lack of resources, including a lack of personal protective equipment, or PPE.

It's important to work on the recognition of the profession, but it's also important to give it more resources, whether by facilitating access to PPE or by giving it more financial resources. Better funding could help put in place more projects that focus, for instance, on training midwives and even on recognizing midwives.

So I'd like to know more about this lack of resources. Ms. Aerts, one of the things you talked about was PPE.

Ms. Giroux, I'd also like to hear your comments about this lack of resources.

[Louise Aerts]

One of them, of course, is the PPE. Another is about the different supports that can be in place. There are different structures across Canada for how midwives are compensated. In some jurisdictions it is an employment model and in other jurisdictions it's a fee-for-service model. British Columbia and Ontario, as our two largest providers, are fee-for-service models.

There wasn't a lot in terms of supports, so that meant there were no sick days. The pandemic relief funding that came out for physicians, for example, didn't immediately follow for midwives. It was something that had to be thought out by the associations in the different jurisdictions to support those kinds of needs. In fact, all the jurisdictions are sort of catching up on that front, but I think that was a major one.

Again, if you needed to isolate, if you didn't work, you didn't get paid, so that was very impactful for midwives in the fee-for-service areas.

[Andréanne Larouche, Bloc, Shefford, QC]

Ms. Giroux, do you have anything to add about the lack of resources and this recognition that could also improve the development of the midwifery profession?

[Josyane Giroux]

Thank you for the question.

In fact, the pandemic has exacerbated the problems we have, including the lack of midwives, which I mentioned. In the short term, these are things we couldn't necessarily address. However, the lack of resources for our professional association, among others, was particularly noticeable. During the pandemic, considerable effort has been made to support members with all the new developments, from all the new clinical guidelines to implementing the measures and obtaining protective equipment. Having worked with all the professional associations across the country, I can confirm that we were all in the same situation, and it would have helped us tremendously at that time to have additional resources.

Obviously, I'm talking about financial resources that would allow us to have people working with us.

The challenges facing midwifery fall to few people. As we move forward, that's one of the important things to look at in terms of the development of the profession.

[Andréanne Larouche, Bloc, Shefford, QC]

Beyond recognition, the federal government is increasing health transfers. Quebec and the other provinces should be given more financial resources to help the profession develop. That's what I understand from your remarks.

A witness on a previous panel made the connection between childbirth and the importance of midwifery for women in indigenous communities. This person even made the connection to residential schools and argued that, in the spirit of reconciliation, recognizing that midwifery and the assistance of midwives in caring for babies from birth in indigenous communities could really help the reconciliation process.

Ms. Aerts or Ms. Dion Fletcher, I invite you to share your opinion on the matter, or even Ms. Giroux, who raised the issue of the importance of recognizing midwives in indigenous communities, even in Quebec.

[Louise Aerts]

Claire, why don't you take that one?

[Claire Dion Fletcher]

Thank you.

Yes, this is something that is important in all of the provinces and in Quebec as well. Again, I'm going to reference the numerous supports we have that speak to this and that speak to the importance of indigenous midwifery in improving health outcomes but also as a step toward reconciliation and ensuring that our knowledge and our ways of being are protected and that we provide a protective force for our families. We take care of our families. We work to keep our families together, and midwives play a crucial role in that.

As the previous witness, Ellen Blais, said—and I'm sure as Brenda would speak to, and any indigenous midwife I know—the role we play not just in promoting the well-being of our communities but also in showing the strength of our families and how we can parent our children is crucial to our families' staying together. To the numerous systems in this country that try to take our families apart, it's just showing that we can parent and that we can parent well.

[The Chair, Conservative, Marilyn Gladu]

Very good.

For the last round of questioning, we have Ms. Mathyssen for six minutes.

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

Thank you so much, Madam Chair.

Thank you to the witnesses.

In previous days on this study, we heard specifically a recommendation from.... Forgive me; I forget. I think it was a couple of the witnesses. Anyway, they said that they would like to see a national chief midwifery officer and the creation of that national branch.

Ms. Aerts, could you speak to how the federal government could support that and if that would be beneficial?

[Louise Aerts]

I absolutely think it would be beneficial. I use an analogy borrowed from someone else: We need a conductor. That type of role and that type of person could help to serve as the conductor to be able to think about all the different pieces and how to allocate the monies and look at midwifery from that big-picture perspective. I absolutely think that there would be a need for and a benefit to such a position.

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

Ms. Dion Fletcher, how could this office better support, without subsuming, and be an ally and be there with a new movement towards indigenous midwives? Do you see it as a separate office, or have you thought about that? Has there been a recommendation going forward?

You talked about all the different types of indigenous midwifery, so could it go hand in hand?

[Claire Dion Fletcher]

I think that needs a little bit more thought and a little more planning, but I do think that there are ways we can work together.

Even from this panel today, and also on other days, all of the midwives who've been speaking have talked about indigenous midwifery. I think that's something to highlight. Whether the midwives are indigenous or not, there is a strong recognition of the importance of indigenous midwifery from our non-indigenous midwifery colleagues.

We only need to look at the very strong partnership between the Canadian Association of Midwives and the National Aboriginal Council of Midwives to see ways that we have figured out to work together and to support each other. We often think about non-indigenous organizations as being the support for indigenous organizations, and that is a notion that we really try to disrupt at NACM and CAM. We actually see the ways that the National Aboriginal Council of Midwives has contributed to the development of the Canadian Association of Midwives and how we work together at a partnership level. That is something that could extend to this midwifery chief officer, and we would be able to think about it and work that through.

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

I find it fascinating, at least in Ontario, where I'm a member of Parliament, that midwifery services have been delivered for 30 years, yet there is this constant push-back and there isn't recognition within hospitals that there is this underpayment. Again, in Ontario, they've been fighting for pay equity. They've actually been working through the Human Rights Commission for pay equity.

Ms. Giroux, you spoke about that specifically. Is there a similar movement in Quebec? Are Quebec midwives looking at that? You specifically addressed pay equity as a huge deterrent to attracting some midwives as well.

[Josyane Giroux]

Thank you for the question.

Legally, the situation in Quebec is very different from that in Ontario. The Pay Equity Act applies to the midwifery profession. However, the way the act was written, and the things I mentioned today, only the top level is considered in job evaluation. There are all kinds of ways to look at it and see that in fact the 20% pay differential I was talking about earlier is seen at the career level. So how were the pay scales designed? How are midwives' time commitments to all the families they serve recognized or not? There isn't much financial recognition for this.

The challenges remain very significant. We address them in different ways depending on the context. I think the pandemic has highlighted issues around gender discrimination, and we're talking about a number of health care professions that are primarily occupied by women.

We want to continue to work towards that, because that's the reality. I can say that the situation is the same for midwives across the country. They all face these challenges.

[The Chair, Conservative, Marilyn Gladu]

Very good. That is the end of our time for today.

I thank our witnesses for your service to women in Canada, and also for your testimony today and helping us with our report.

For committee members, you will have received the second draft of the unpaid work study. Is it okay to request that all of your supplemental or dissenting reports be submitted by June 1, which is next Tuesday, in order that we stay on schedule to be able to table that report? Is that okay? Yes? That's good. All right.

I would remind you that our meeting on Thursday is from 6:30 to 8:30 in the evening, Eastern Standard Time, and we will be finishing up the women's unpaid work study and then moving on to the report on sexual misconduct in the military.

Is it the pleasure of the committee to adjourn? Seeing that it is, we shall see you on Thursday night.

Thanks again. Have a great day.

The meeting is adjourned.