Mr. Speaker, Bill C-608 designates May 5 each year as a national day of the midwife. I rise to support this bill.
However, I want to make a side comment. We seem to be debating more and more bills that recognize a particular day for a profession or a cause. While these are all very useful in bringing awareness and importance to the cause, I hope we are not in danger of watering down the effect by having a day for everything. Sooner or later we will not pay attention to the days anymore.
This is an important issue, though. I believe this bill is important in recognizing the role of the midwife as part of a health care team in low-risk deliveries. In fact, we now know that most low-risk deliveries should be delivered by a primary care provider. In some areas that could include a midwife and in other areas it could include a nurse practitioner trained in midwifery. In others it could be a family physician who is trained in midwifery.
Midwifery is a way of providing quality, timely, cost-effective, patient-centred care, and I want to stress more than anything else the use of these primary care providers in terms of low-risk deliveries.
Women with high-risk pregnancies obviously should be handled in a hospital setting by an obstetrician, but in Canada more and more people with low-risk pregnancies are going directly to obstetricians. This increases the cost of care, and it does not give the quality of care and the continuity of care that a primary care provider such as a nurse practitioner, a family physician, or a midwife can provide to a patient.
Midwives play an essential role in promoting health and reducing maternal and infant mortality globally. Members have heard from my colleague from the Conservatives speak to that point just now. In fact, midwives are expert primary care providers in low-risk pregnancies and births and can optimize the childbirth experience for women at all risk levels.
It may be useful, however, to look at home birth statistics in Canada.
A lot of midwives I know prefer home birth and promote home birth. In some hospitals in some parts of Canada, they are an essential part of a team within the hospital setting.
Midwives performed 2,360 home births in 2008, which is an increase in home births of 25% in only five years. There are no national home birth statistics, but the percentage of non-hospital births in Canada more than tripled between 1991 and 2007. This increase coincides with the sudden rise in use of midwives within a low-risk birth experience.
Healthy women who are pregnant, however—and this is just me speaking as a physician—should always know that there is a 40% chance during actual birthing of having some kind of high-risk intervention necessary. In very large busy cities, it is often difficult at that point to get a person who has a complication from home to a hospital setting to deliver safely.
According to the chief of maternal-fetal medicine at Toronto's Sunnybrook Health Sciences Centre, women must therefore look carefully at home births as an option.
However, in countries with very high infant and maternal mortality rates where there is no basic health system in place, a midwife, and in some cases not even a fully qualified midwife, is an option in some faraway villages to have somebody with some training, no matter how small, available to provide a birthing at home. In the rainy season in many developing countries, a passable road cannot be found to get to a birthing centre that has all of the equipment.
Midwives have had a huge role in bringing down infant and maternal mortality, globally and especially in the developing world. Here in Canada, home births account for approximately 2% of all births in Canada, the U.S., and most western European countries, with the exception of the Netherlands, where home births account for one-third of all births.
I think it is appropriate to say that in Canada we only have midwives registered in B.C., Alberta, Manitoba, Ontario, Quebec, and the Northwest Territories. It might be interesting for other provinces to look at the role of the midwife as part of a primary care team in low-risk pregnancy and delivery.
There are currently seven midwifery education programs available in Canada. The program is a four-year baccalaureate program.
Midwives are and should become a larger part of health-care systems not only here in Canada but around the world.
Between 2000 and 2010, the number of births attended by midwives in the United States rose by 41%. Bangladesh, one of the few countries that have actually met millennium goals four and five on infant and maternal mortality and morbidity, actually committed to training an additional 3,000 midwives to reach the millennium goals, which is an extraordinary thing to happen.
Afghanistan has committed to increasing the number of midwives from 2,400 to 4,500 in a short period of time. Ethiopia has committed to increasing the number of midwives from 2,000 to 8,000. Rwanda has committed to training five times more midwives, which increases the ratio, sadly, from one to 100,000 to one to 20,000. It would be really nice to have a better ratio. In some of these countries, the ability of midwives to train to deliver babies is a core and essential part of looking at mortality and morbidity during pregnancy and childhood.
In 2010, the global strategy for women and children's health noted that an additional 3.5 million health workers, and that includes midwives, are required to improve the health of women and children substantially in the 49 lowest-income countries. The World Health Organization recommends one skilled birth attendant for every 175 pregnant women. I refer back to the fact that Rwanda is moving from one for 100,000 women to one for 20,000, when we know that the ideal ratio is one for 175.
There is much work to be done in looking at the role of midwives, not only in the developing world and not only globally but here in Canada and in some of our isolated areas.
I want to thank the member for bringing this issue forward. The more Canadians understand midwives and what they do and we look at better community care models of care, we will see midwives playing an essential role in that compendium of care and in that comprehensive list of caregivers.