Midwives are trained healthcare professionals who work as the primary healthcare providers for pregnant people before, during, and after birth. Before birth, midwives have regular appointments with patients where they conduct check-ups, along with providing education and helping plan for the birth and everything that comes after. The delivery may be conducted at a hospital, the client’s home, or a birthing centre. After the birth, midwives continue to support the parents and baby for up to six weeks.
One of the benefits of choosing a midwife as your primary healthcare provider for your pregnancy is that midwives have a lower client load than family doctors or obstetricians.
“As a midwife, I take care of maybe forty clients per year. I have a lot more time to talk to a client about not only physically what she’s doing during her pregnancy but, preparing her mentally… So you get a lot more personalized and specialized care,” said Heidi Johnston.
“Average family doctors take care of anywhere upwards of two to three thousand patients per year. They might have two or three hundred pregnant people. They don’t have the time to spend talking about all sorts of things like breastfeeding and labour support. Their visit appointment times are maybe ten, fifteen minutes long. Obstetricians, they’re even busier than that,” said Johnston.
Last July, the Ontario provincial government announced its pledge of 28 million to expand midwifery services in the province. However, the announcement has been criticized as being misleading.
When the Ontario midwives submitted their budgets back in 2017, three years ago, little did they know that they would be working with this funding until now. The recent announcement from the Liberal Government was simply referring to the budget they were granted back then according to Johnston, Head midwife at Grand River Hospital.
In addition, access to that funding may be more complicated than people realize. A lot of the funding cannot be accessed by many hospitals. The current contract with the Ministry of Health allocates different funding for general registrants or midwives practicing for more than one year and new graduates entering the field who have been practicing for less than a year. General registrants cannot access new graduate funding and vice versa.
The issue, however, is that many hospitals cannot hire new midwives and are therefore not able to access funding allocated to new graduates.
“We’re capped at our number of 28 midwives that work there. So, this money, basically, at the end of the fiscal year, gets returned back to the government, and then they will look and say, ‘You didn’t use all your money. So when you’re asking for it next year, you’re not going to get it, because you didn’t use it.’ Whereas if they actually just gave us cheques for 1.2 million, there’s plenty of things we would’ve spent that money on,” said Johnston.
Increases in midwife hiring are complicated as they depend on other factors at a hospital. If the number of midwives at a hospital rises, so must the number of obstetricians. More obstetricians mean more demand for limited Operating Room space. Therefore, hospital budgets in general affect midwife hiring and subsequent funding. It has been difficult for hospitals to hire new midwives already, but it has become even more difficult as there have been several cuts to other areas of healthcare.
These issues regarding funding strike a particularly sensitive nerve as midwives in Ontario have been known to be underpaid already. In 2018, the Human Rights Tribunal of Ontario found that midwives in Ontario were experiencing gender-based pay discrimination in their relationship with the Ontario Ministry of Health and Long-Term Care.
Although the tribunal ruled that midwives should be better compensated for their work, there has not been a reactionary increase in pay.