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Midwifery as a Career

Midwifery and midwifery-led births

There are over 1900 midwives practicing across Canada, external link.  Midwives are registered health-care professionals who provide primary care to clients with low-risk pregnancies — from the time of conception until six weeks postpartum (after birth). Midwives work in community-based group practices with a team of other midwives, providing care on a 24 hour, seven-day-a-week model. No two days will be alike. Working as a midwife requires a keen intelligence combined with flexibility and compassion. Midwives collaborate with other health care providers such as physicians, nurses and social workers.

Midwifery is a career that allows you to use your head, your hands, and your heart. Working as a midwife requires resourcefulness and adaptability. Working with clients and their families during the childbearing year offers many satisfactions as well as challenges.

Highly trained health professionals, midwives are required to have a four-year university degree, must qualify for registration with the College of Midwives of Ontario (CMO), external link, and are expected to engage in lifelong learning. Midwives need a thorough understanding of normal and complex conditions affecting pregnancy, birth, and the postpartum care of women and the newborn. They must draw on a large body of knowledge and sometimes make clinical judgments under stressful or emergency situations. Midwives participate in health care planning and policy making at local, national and international levels.

In addition to being responsible for supervising the birth process - conducting spontaneous, normal vaginal births in both hospital and out of hospital settings - midwives provide ongoing clinical care for clients throughout pregnancy. After birth, they counsel clients and their families on infant care and continue to monitor the client’s and infant's health for a six week period. Manual dexterity is required in assisting clients through labour and birth and in tasks such as giving injections, setting up IVs, suturing perineal tears, and conducting physical examinations of clients and newborn babies.

Communication, cultural sensitivity and counseling skills are essential components of midwifery work. Midwives get to know the clients they care for, developing an awareness of their needs and earning their confidence. Collaboration with other members of the health care team requires well developed communication skills. Midwives build non-authoritarian relationships with clients and their families, enabling midwives to provide individualized, responsive care and minimizing much of the anxiety often associated with pregnancy and childbirth.

In 2019, Ontario midwives celebrated the completion of twenty-five years of regulated and funded midwifery and currently, there were over 900 registered midwives practicing in Ontario, external link

In 1993, Ontario was the first province in Canada to regulate and legislate midwifery. The profession is now regulated in British Columbia, Alberta, Manitoba, Saskatchewan, Quebec and the Northwest Territories. Other provinces and territories are in the process of integrating midwifery into their health care systems.

The Ontario model of midwifery is based on three principles:

  • Continuity of Care - Midwifery care is available to clients throughout their pregnancy, labour, birth, and the first six weeks after birth. Midwives spend time developing relationships with clients and are available 24 hours a day, seven days a week. Surveys of midwifery clients in Ontario have shown that clients consistently give high priority to working with a "known care provider." Clients value the opportunity to develop a trusting relationship with their midwives. This relationship allows midwives to provide individualized and responsive care. A known care provider removes much of the anxiety from childbirth, and this often results in greater client satisfaction and fewer costly interventions.
  • Informed Choice - Midwifery clients may choose to give birth at home or in hospital or in a free standing birth centre if there is one in their neighborhood. Midwives maintain hospital privileges at many Ontario hospitals and work collaboratively with other health care practitioners.
  • Choice of Birthplace - Midwifery clients may choose to give birth at home or in hospital. Midwives maintain hospital privileges at many Ontario hospitals and work collaboratively with other health care practitioners.

There are two routes by which midwives can achieve registration in Ontario.

First, they may graduate from the Ontario Midwifery Education Program (MEP). This is the four-year BHSc (Midwifery) degree Program offered by a consortium of three universities - Toronto Metropolitan University, McMaster, external link and Laurentian, external link Universities.

The second route is for those midwives who have been educated in other jurisdictions and who may qualify for registration by completing the International Midwifery Pre-Registration Program (IMPP) through Toronto Metropolitan University Continuing Education Department. The MEP and IMPP thoroughly prepare midwives to support, counsel, monitor, and assist pregnant and birthing women and their babies. Midwives must also fulfill the College of Midwives of Ontario, external link's registration requirements.

Each year approximately 90 new midwives are registered which will make midwifery care available to more women throughout Ontario. Continuing education is mandatory for all midwives in Ontario. Midwives are constantly upgrading their skills and participating in regular mandatory peer review. Colleagues and clients provide ongoing, formal feedback that ensures midwives are providing high quality, responsive care.

As a partner in the Ontario Midwifery Education Program, Toronto Metropolitan University collaborates with the Association of Ontario Midwives (AOM), external link, the College of Midwives of Ontario and midwifery consumer groups to continue the development of an outstanding midwifery care system for women and their families in Ontario.

Legislation and Regulations related to Midwifery, external link

Statistics gathered since 1994 have consistently shown that midwife-delivered babies are healthy, and have less need for further hospitalization or medical attention. International evidence overwhelmingly supports the fact that midwifery care is as safe and efficient as care by other providers. Data gathered in Ontario both before and after regulation (1994) is consistent with international evidence about midwifery.

There is strong evidence that midwifery contributes to improving both short term and long term health outcomes. A 2016 Cochrane review, external link of the evidence on midwifery-led models of care reported on 15 randomized controlled trials involving 17,674 cases. This review showed lower rates of intervention in birth and less pre-term labour and fetal loss <24 weeks. Those with midwifery-led care had higher rates of normal spontaneous vaginal birth, shorter hospital stays and higher rates of breast-feeding.  Midwifery clients reported higher rates of satisfaction and feelings of control. The Cochrane review concluded that "most women should be offered midwife-led models of care and women should be encouraged to ask for this option". Collaborative models of care with midwives and obstetricians are recommended for those with medical or obstetric complications. Reducing rates of pre-term labour and increasing rates of vaginal birth and breast-feeding have long term health implications, reducing chronic respiratory and auto-immune disease.