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Prairie Women's Health Centre of Excellence

 
Midwifery and Maternity Care
 
     
  Midwifery in Saskatchewan - An Update
April 18, 2007


Midwifery Services - This Summer?

On November 7, 2005, the Government of Saskatchewan's Speech from the Throne announced:
"Over the years, government has heard from many, calling for new services in midwifery. In the coming months, support for midwifery services will be provided. Midwives will offer their skill and training as part of multi-disciplinary teams in hospital and community settings, contributing to care that is safe, flexible and meets the needs of families."
Over the last year and a half, midwives, midwifery consumers, government officials and health professionals have been working diligently to bring midwifery to Saskatchewan.

The provincial government will fund midwifery care provided by midwives who will be hired staff of the Health Regions. Initially midwives had suggested having independent practice, with payment per service or course of care, as an alternative or complementary option to health region services that would offer more independence and flexibility for midwives and clients. The benefits of the chosen model are recognized, but there may be interest on the part of midwives in also having other options available in the future.

The intent is to have midwifery services available throughout the province, but the government is starting with two initiation sites. The Regina site may be operational as early as June 2007, and the Saskatoon site will likely follow later.

The Midwifery Act was passed in 1999. Parts of the Act were finally proclaimed this winter, to enable the formation of a Transitional Council. The government can proclaim the rest of the Act when the regulations, bylaws etc are ready, the Legislature does not have to be sitting. One cannot predict political decisions, but the NDP government is nearing the end of its current mandate, and a spring or fall election is possible in the province, which would influence the current government decisions on proclamation.

Saskatchewan Health had set up the Midwifery Implementation Committee to guide the establishment of midwifery. The Committee was composed mainly of representatives of health professional organizations, and had one consumer representative participating for a time. Working groups have been addressing:
  • regulations and bylaws, (standards of practice, competencies, ethics)

  • labour relations/human resources,

  • communications (information for public and professionals about midwifery and the implementation process),

  • site implementation (at the provincial level and local committees in Regina and Saskatoon, plans for midwifery initiation sites, working with health regions, hospitals and other health facilities and health professions to develop collaborative working relationships with midwives.)
In March 2007 Saskatchewan Health appointed a Transitional Council to guide midwifery until there are enough midwives in the province to form a College of Midwives. Most of the members are continuing on from the previous Midwifery Implementation Committee. The ten-person Council includes representatives of several health professions, but only two midwives, even though the legislation allows for there to be up to five midwives on the Council. This is of concern to midwives and consumers. On the positive side, the person appointed to the Council to represent the public interest is a First Nations woman with northern nursing experience who will bring an important perspective to the Council.

An important difficulty determined as the regulations were being developed is that the definition of midwifery practice in the Midwifery Act does not mention care of the mother and infant after birth, or well woman care. "Authorized practices - 23(1) Subject to the terms, conditions and limitations of that member's licence, a member may perform the following authorized practices: (a) act as a primary care giver in managing pregnancy and labour, including the spontaneous normal vaginal delivery of a baby;" เกมออนไลน์ที่ดีที่สุดhttp://www.qp.gov.sk.ca/index.cfm?fuseaction=publications.details&p=2788 Midwives and consumers would prefer that the Act be amended before it is proclaimed, so the definition is complete, for the sake of clarity and liability. On the other hand, an amendment does not seem to be on the Legislative Agenda for the Spring 2007 session, including it at this time would require the approval of the Government and Opposition parties, delaying it until the Fall session would delay midwifery implementation.

A bursary has been established by Saskatchewan Health to enable midwives to access training or prior learning assessment (เกมออนไลน์ที่ดีที่สุดhttp://www.health.gov.sk.ca/hhrp_bursaries.html). Two midwives used the bursary to access the International Midwives Pre-Registration Program in Toronto, which offers rigorous academic and clinical skills assessment.

The Western Academy of Midwifery was initiated in the Fall of 2006 and began accepting students in January 2007. From its home in Regina, with the involvement of midwives and other experienced educators from Canada and the U.S., WAM will provide a 4-year distance education program in academic and clinical requirements for Canadian midwifery practice. Second attendant and doula training is also offered. (http://www.wamidwifery.com/)

The progress of the Aboriginal Midwifery Education Program in Manitoba has been viewed with great interest. The work of AMEP led to the formation of the Kan醕?Otinaw醱asowin (Aboriginal Midwifery) Baccalaureate Program (KOBP) at the University College of the North, with its two main campuses in Thompson and The Pas, Manitoba. (https://www.keewatincc.mb.ca/)

Upcoming topics that will need to be addressed:
  • Aboriginal women: The province has not instituted any specific provisions regarding traditional Aboriginal midwifery as has occurred in some other provinces, but states it will consider aspects of working with Aboriginal women in its program development and service delivery. The diversity within cultures and the differences between access to services for First Nations, M閠is and Inuit women will need to be considered. Programs such as the Canada Prenatal Nutrition Program and the Maternal Child health Home visiting Program on reserve could complement midwifery services. These considerations will also be important for midwifery and doula training.

  • Women living on Reserve: The federal-provincial responsibility issues for midwifery care for women living on reserves will need to be addressed. There is interest in midwifery among women and First Nations and Inuit Health, Health Canada has a strong interest in improving maternal and infant care and bringing safe birthing closer to home.

  • Training and skills development: More options for learning midwifery have been established and are developing in the province, but accessing training, and the ways to obtain specific skills to meet registration requirements will require further attention. Currently discussions are being held within the involved health regions and health professionals on assisting midwives in skill development. This will be important to currently practicing midwives who complete Prior Learning Assessments and require additional skills training in selected areas to integrate with the new role of midwives in Saskatchewan.

  • Number of midwives: The Regina and Saskatoon sites will be hiring midwives in the near future. Interest has been expressed by Saskatchewan midwives, former Saskatchewan Residents and midwives from other areas in Canada in practising in Saskatchewan, so fears that there would not be enough midwives initially may be dispelled. In the long run though it will be important to have the additional training options in the province that are now being developed.

  • Geographic Access: Women and health professionals in rural and northern areas are expressing a desire to have midwifery services in their area. Long-term plans for making midwifery accessible to women in all health regions, urban, rural and northern, will need to be developed.

  • Diversity: Communication to women and providing appropriate service delivery to a diversity of women and respecting different cultures will be an ongoing part of midwifery. It will be valuable to involve midwifery consumers in providing feedback and guidance on midwifery care.

  • Registration: Establishing a registration process and college.

  • Communications: Informing the public and health professionals about midwifery. As time has passed there has been some media coverage about midwifery developments, but the public education being developed by the Communications committee will be important for health professionals, health organizations, women and their families.

  • Evaluation: Evaluation tools and process will be needed to assess the success of midwifery and provide feedback for continuing improvement.
Prepared by Joanne Havelock, Prairie Women's Health Centre of Excellence, April 3, 2007.

For more information email pwhce@uregina.ca, tel: (306) 585-5727. Or mail:
Prairie Womens Health Centre of Excellence
CB 309 College Building
University of Regina Extension
College & Scarth
Regina, Saskatchewan
S4S 0A2