Like many career paths in the healthcare industry, midwives are in high demand, and have been for many years. Canadian midwifery experts say that only around half the amount of people who seek midwifery services are able to obtain them. Just over 25,000 people gave birth in midwifery care between April 2018 and March 2019.
But for a career that has historically been around almost as long as people have been giving birth, the industry still has challenges, making it difficult for midwives to meet the growing demand for their services.
In Ontario, midwives provide an Ontario Health Insurance Plan-funded alternative to primary care to pregnant people. Midwives are often confused with doulas, who are not medical professionals and provide emotional and physical support during during birth, whike midwives are, in fact, trained health professionals.
Midwifery offers more hands-on, long-term pregnancy care; your midwife provides complete care from pregnancy, through birth and until six weeks after labour. Midwives provide continuous physical assessments and prenatal education, and through a midwife, you have the choice between giving birth at a hospital, at home or at a midwifery birthing centre.
Hana Lang has worked as a midwife in Toronto as well as British Columbia, where she currently practises in a small rural community. She says that what drew her to the profession was the model of care.
“The midwifery continuity of care, and of establishing relationships with your clients, especially perhaps those in marginalized or vulnerable communities, allows me to provide a level of care that I just don’t think you can replicate with any other model,” she says.
Nowadays, Lang says she works primarily with Indigenous folks.
“By establishing a relationship with them over the course of their pregnancy, they’re more likely to perhaps reach out and ask for help navigating social systems,” she says.
Jasmin Tecson, president of the Association of Ontario Midwives, says that midwifery usually appeals to those who are interested in working with people directly.
“People who have an interest in health care and are interested in some way in reproductive rights or reproductive justice,” she adds. “We’re interested in working with people in a way that empowers them and developing a relationship with them.”
Tecson says the three elements of the midwifery philosophy are informed choice, continuity of care—where a person has a working relationship with their care provider all the way through the process—and birthplace choice.
“If clients are wanting an experience and choices that give them more room to incorporate alternatives or to see where the natural process goes without assumptions, then midwifery is a great model for them to receive care in,” she says.
Lang says many midwives are leaving the profession. A November survey of midwives in British Columbia found that one in five were taking active steps to find new lines of work.
“It comes down to a general lack of support from the government,” Lang says, noting that midwives don’t have paid sick leave, on top of the fee-for-service model many have to follow.
“What that means is if you don’t work, you don’t get paid,” she explains. “But given the nature of our work, and given the requirement of being on call 24/7, there’s just no safety net.”
Tecson also points to the complicated layers of how midwives are regulated in Ontario. The Ontario Ministry of Health controls how many midwives are practising and where at any given time. Additionally, only certain midwives are given privileges at certain hospitals.
“If you can’t be privileged in a hospital, you can’t provide the full complement of care services. Hospitals in many areas have limits on the number of midwives who can be privileged there – that therefore limits the number of midwives who can be employed at a practice and can be paid,” she says.
In order to retain midwives who are currently practicing, Tecson highlights the importance of fair pay. The Human Rights Tribunal of Ontario (HRTO) recently ruled that the Ministry of Health and Long-Term Care had set up a discriminatory pay structure for midwives over the past 20 years due to gender discrimination (midwifery is the most exclusively woman-dominated profession in the province).
At the time of the HRTO case, the salary of the comparative field of a community health centre family physician, a traditionally male-dominated field, can be up to $220,000. The average salary of a midwife averages around $100,000.
“Midwives need to see that they’re included in policies and decision-making in planning of key issues…and also the flexibility to practise according to their full scope,” Tecson says.
Better pay, more job stability, and respect from the industry—all are gaps shared by similar healthcare fields dominated by women and racialized people.