Many women have requested midwifery services, have considered it or know someone who has used a midwife for their maternal needs. Midwives in Canada are regulated by professional colleges, similar to physicians and provide care for low-risk pregnancies throughout pregnancy, labor and 6 weeks following birth. For example, in Ontario, if you see a midwife you will not see a physician, unless there are complications. Midwives services are completely covered by government funding and clients do not need to pay for services; this is true for all residents of Ontario regardless of immigration or OHIP status. These healthcare professionals work with the women under their care, supporting them, advising them and caring for the mother and the newborn baby. A midwife’s care is not limited to conducting births; they also emphasize prevention and detect pregnancy complications. In addition to these duties, they assume the role of a health counsellor and an antenatal educator.
Midwife, Manavi Handa, from the West End Midwives practice, accurately describes her broad scope of practice as a midwife in Toronto: “Midwives have a broad scope of practice, can order and interpret all routine tests related to normal pregnancy including ultrasounds, genetic screening, and routine lab work; in addition, they can prescribe medication for conditions associated with pregnancy and are well integrated into the health care system having privileges at local hospitals.”
WHAT IS A MIDWIFE?
The re-emergence of midwifery stemmed from the women’s health movement and second-wave feminism. It was originally considered a ‘fringe’ movement of self-educated women seeking empowerment in their health care. Now midwifery is much more mainstream and more marginalized women are being accommodated. For example, Manavi remarks that midwifery clientele includes people from various cultural, ethnic and socioeconomic backgrounds. Manavi remarks that almost 95% of her clientele are racialized women. When midwifery was legislated over 20 years ago, midwives did less than 1% of births in the province, they now, however, do close to 15%. So, midwifery has come a long way; people, however, continue to have misconceptions of what midwives do.
MISCONCEPTIONS ABOUT MIDWIFERY
Ms. Handa notes the presence of misconceptions in the realm of midwives’ education. What many people don’t know is that, in Canada, midwives must complete a 4-year university degree. Another erroneous belief is that you have to have a homebirth if you have a midwife work in homes. However, midwives offer delivery where their clients feel most comfortable, whether it be at home or in a hospital. All midwives in Ontario have privileges at hospitals and 80% of midwifery births in Ontario occur in the hospital setting.
THE BENEFITS OF MIDWIFERY
This profession is a rewarding one, benefiting both midwives and their patients. Manavi likes that she is able to provide comprehensive care to any woman who is a resident living in Ontario, regardless of immigration or insurance status — which means she is able to provide care to women in immigration limbo and refugees. She also notes that it benefits pregnant racialized women: “For marginalized women, in particular, midwifery can be particularly beneficial because it is such an individualized type of care that can make them really feel supported and empowered in the health care system where they often are really marginalized.” Because midwifery is not well known or recognized in immigrant and marginalized communities, this is reflected in the midwifery student body. While the number of students in midwifery education programs is diverse, it is not reflective of the diversity of our province. In addition to increased knowledge in immigrant communities for midwifery clients, outreach is important so more people from diverse backgrounds can enter the profession. As a child of South Asian immigrants, Manavi explained that one of the greatest rewards of her profession is working with women from within her own community. “I would love to see more students representing different communities in the profession — both to benefit the women they serve and provide more culturally-sensitive care, but also as a benefit to the student who will be making change in our health care system.”