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The Time is Now: Midwifery in Canada

posted Nov 18, 2013, 7:12 PM by Megan Black

Pregnancy and childbirth are two fundamental aspects of reproduction that naturally transpire and are unique to every woman and her specific circumstances. In Canada, pregnancy and childbirth have become increasingly understood as a medical condition rather than a natural life process. Maternity has become medicalized in Canada; it is explained and understood in medical terms and is treated as a medical problem. For example, approximately 99% of the 333,000 babies born each year in Canada are delivered in hospitals (Parry, 2008). In addition, 75% of women who give birth in a Canadian hospital will undergo a medical procedure (Parry, 2008). Medical procedures and interventions such as cesarean section and induced labour are being performed more frequently on women in Canada and are occasionally unnecessary.

Medicalization teaches us that the safest approach to treat a condition is through modern medicine and professional medical care. However, the medicalization of pregnancy and childbirth often actually threatens the health of women and their children in Canada. On a global scale, Canada’s maternal and infant health status fairs poorly in comparison to other countries, as Canada has the 33rd “best” maternal mortality ratio and infant mortality rate (World Bank, 2011).  In other words, 32 countries are providing better maternal care to women and their children than what is provided in Canada. Considering that Canada is a “developed” country and is often looked at as having a model health care system, the proportion of maternal and infant deaths is alarming and a cause for concern. Consequently, it is necessary to revise the maternal health care system in Canada. Sweden is among the top 32 countries with a maternal mortality ratio and infant mortality rate lower than Canada (World Bank, 2011). Their maternal health care system is based on “equity and an alliance between midwives and doctors.” A midwife is described as a health professional that provides primary care to women and their babies during pregnancy, labour, birth and the postpartum period.

Obstetricians have suggested that the “safety” of mothers and babies are jeopardized when cared for by midwives. However, midwives provide a service that is equally as safe as obstetrics and also produces better outcomes for women and their children. Although some obstetricians oppose the inclusion of midwifery into the maternal health care system in Canada, they are in no position to be refusing help. Canada has experienced a 50% decrease in the proportion of family physicians providing obstetric services from 1982 to 2000 (Buske, 2001). Integrating midwifery into maternal health care in Canada would alleviate the burden on physicians in a cost effective manner.

Furthermore, the integration of midwifery into maternal health care in Canada would help restore female autonomy. The reproductive rights of women in Canada include “the right to reproductive self-determination,” however, a woman’s control over her reproductive rights is determined by the province or territory she lives in. Even though midwives have been a part of maternal health care in Canada since the early 1990s, political and medical mainstream forces have marginalized midwifery. The true ability of midwifery in Canada over the past few decades has not been properly represented due to limitations caused by legislation and a lack of government funding. Only select provinces including Ontario, British Columbia and Manitoba have legislation permitting the use of midwives for home and hospital births, as well as government funding. Consequently, Ontario, British Columbia and Manitoba are the only three of 13 provinces and territories in Canada that truly emulate functional midwifery services. If midwifery were included in maternal health care, women in Canada would have the ability to choose the maternal service right for them.

Additionally, not only do midwives provide excellent care antenatal care but also excellent postpartum care. Care during the postpartum period is extremely important as 15-30% of new moms develop postpartum depression or perinatal mood disorder. The support, counseling, understanding, and explanation given to women by midwives in the postnatal period provides benefits to psychological well-being. Midwifery is a safe, cost effective and liberating maternal health care service. The status of maternal heath in Canada would undoubtedly improve on a national scale through the incorporation of midwifery into the maternal health care system.

 

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