Need for Ontario midwives 'past the tipping point,' say pros

For Simone Rosenberg and her five siblings, delivering a baby at home was never a big deal.

Each one of them was caught by a midwife. For Rosenberg herself, in 1982, the profession hadn't yet been regulated. "It was a role in the community I was familiar with—kind of like a firefighter," she said. 

At 19, she watched her youngest brother come into the world at the coaxing of a midwife and discovered her calling.

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Rosenberg is now one of about 800 registered midwives in Ontario. She says that, in Toronto, waiting lists for her services are "pretty typical."

Over 4,000 midwives from around the world addressed inaccessibility to their services this weekend as part of the International Confederation of Midwives congress in Toronto.

"We know that midwives save lives," said one speaker during a congress rally, the March for More Midwives, on Saturday. "But we also know that there are not enough of us...even here in Canada."

Birth is a 'healthy, normal process', says midwife

The march was a reminder that "supply has always been less than demand," said Elizabeth Brandeis, president of the Association of Ontario Midwives.

Here in Ontario, 27 per cent of midwife requests are turned down—not due to dearth of interest in the profession or even lacklustre government support, says Brandeis, but because of "systemic obstacles that stand in the way."

Midwives deliver babies at home and in birthing centres, but also work in hospitals—when the hospital budget allows, explained Brandeis, who said the lack of hospital privileges is the primary reason for the access gap.

There are often budget caps on the number of midwife-facilitated births that can occur at any one hospital, she said. That leads to waiting lists so long they prevented a quarter of women who wanted a midwife from obtaining one in 2016.

In 2006, about 40 per cent of requests fell through.

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"It does come down to money to some degree, but it also comes down to power and influence," said Brandeis. "Physicians still control decision making in hospitals and that affects what happens at the systemic level."

Brandeis also suggested that cultural expectations of care may need to shift before midwifery is normalized. "We need to start seeing birth as a healthy, normal process," and provide appropriate care for low-risk situations, she said. 

Midwives now deliver 15 per cent of babies born in Ontario.

'I felt extremely cared for'

North York resident Tammy McIntosh tried to get a midwife near her home, but ended up on a waiting list.

She had to travel to East York for appointments, but shrugged off the inconvenience.

"It's fairly simple" to find a midwife in the city, she said, but noted a friend in Grand Bend, Ont. lived too far from midwifery services and couldn't get one.

McIntosh's midwife came to the hospital to help her with the delivery, and stood by during an emergency caesarean section carried out by a doctor. The midwife also made post-birth house calls, dealing with everything from mental health assessment to weighing McIntosh's son, Carter.

McIntosh pointed to the relief of having someone always on call to handle her new-mom concerns.

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"One time I thought he slept too long," she laughs, "so I paged them and asked all these crazy questions. I felt extremely cared for."

She suspects a doctor may not have had the time to provide such in-depth support. "It was nice to have that reassurance," she said.