Thank you Mr. Chair and committee members for the opportunity to appear today to testify as part of the committee’s study of Bill C-608, An Act respecting a National Day of the Midwife. I would also like to thank the sponsor of the bill, member of Parliament Rosane Doré Lefebvre who introduced this bill in the House of Commons and who has personally championed the cause of midwifery in Canada. We also extend our gratitude to member of Parliament Peggy Nash for the work that she has done to establish a National Day of the Midwife in Canada.

The International Day of the Midwife was formally established in 1992 by the International Confederation of Midwives (ICM). Since then, every year, May 5 marks the day of celebration for midwifery globally, a day that reminds the world of the essential role that midwives play in ensuring healthy outcomes for mothers and their newborns. Statements in support of International Day of the Midwife have been issued by the United Nations Population Fund (UNFPA), the International Federation of Gynecology and Obstetrics (FIGO) and by the World Health Organization (WHO).

The Canadian Association of Midwives firmly believes that Bill C-608 is an important step in showing appreciation for the vital contribution that midwives make to the delivery of safe, quality maternity care to Canadian families and to the important role that midwives play in delivering thousands of healthy Canadian babies.

We would like to thank committee members Dr. Colin Carrie, Dr. Hedy Fry and members of Parliament Lois Brown and Peggy Nash who have echoed this appreciation in their statements delivered in the House of Commons in 2013 and in 2014 in recognition of May 5 as the International Day of the Midwife. And of course, CAM is very grateful to all political parties for the unanimous support the bill has received to date.

The Canadian Association of Midwives is the national organization representing midwives and the profession of midwifery in Canada. CAM's mission is to provide leadership and advocacy for midwifery as a regulated, publicly funded and vital part of the primary maternity care system in all Canadian jurisdictions.

CAM also works to support the interests and objectives of 13 provincial and territorial midwifery associations, as well as the National Aboriginal Council of Midwives (NACM). There are currently just over 1,300 practising midwives in Canada. Midwifery in Canada provides a model of care that is evidence-based, women-centred, safe, and cost-effective. Registered midwives are health professionals who provide primary care to women and their babies during pregnancy, birth and the postpartum period. They are often the first point of entry to maternity services, and are fully responsible for clinical decisions and the management of care within their scope of practice.

Midwifery models of care vary across the country, but all are based on the principles of continuity of care provider, informed choice, and choice of birth place, such as hospitals, birth centres and homes.

Midwives provide a complete course of low-risk prenatal, intrapartum and postnatal care and services for mothers and their newborns. These include physical examinations, screening and diagnostic tests, the assessment of risk and abnormal conditions, and the conduct of normal vaginal deliveries.

Midwives work in collaboration with other health professionals, and consult with or refer individuals to medical specialists as appropriate. In jurisdictions where midwives work to the fullest scope, midwifery practice includes epidural monitoring, induction for post-term pregnancy and augmentation of labour by pharmacological means, prescription or fitting of contraceptives, baby care beyond the six-week postpartum period, and many other aspects of primary care.

Midwives are experts in normal births and therefore help to reduce high rates of interventions. Women who experience midwife-led continuity models of care are less likely to experience antenatal hospitalization, regional analgesia and episiotomy, and their newborns are more likely to have a shorter hospital stay and fewer readmissions.

Midwifery services also help to reduce wait times in emergency rooms because midwives are on-call and directly accessible to their clients 24 hours a day, seven days a week.

According to statistics from Ontario, midwives currently achieve caesarean section rates that match the World Health Organization's recommended rate of 15%. If midwifery care was widely instituted, this reduction alone could potentially save millions of dollars a year in health care spending.

There are seven universities in five provinces offering a four-year midwifery education baccalaureate program, and a number of community-based midwifery education programs in first nations and Inuit communities. In spite of this, only 2% to 5% of women in Canada currently have access to midwifery care services.

And why is this? In New Brunswick, Prince Edward Island, Newfoundland and Labrador, and in the Yukon, the profession is still unregulated and unsupported by the public health care system, so families do not have access to midwifery care.

In federal jurisdictions, such as on reserve, penitentiaries and military bases, communities face numerous barriers when attempting to implement midwifery services. These attempts most often result in failure to improve health services and to offer birthing services closer to home.

The World Health Organization, UN agencies and other global partners have identified midwives as key to achieving reductions in maternal and infant mortality. Through the Muskoka initiative and more recent investments by the government in international maternal, newborn and child health, Canada has played a role globally in helping to increase women’s access to quality maternity care.

However, a 2013 UNICEF report found that Canada domestically ranked 22 out of 29 developed countries for infant mortality rates. This concerning figure is mostly attributed to the higher rates among aboriginal communities where women must leave their community for weeks to give birth in urban centres, away from their families and support systems.

Midwifery can play a significant role in ensuring better access to care for women and their babies and CAM looks forward to opportunities to work with the federal government and with the provinces and territories to improve access to maternal and newborn health care in Canada.

In June 2017, Canada will host the world’s triennial global midwifery congress in Toronto. Over 4,000 midwives and maternity care providers from around the globe will be in Canada to learn and discuss on issues regarding global maternal, newborn and child health. This will be a one of a kind opportunity for us to demonstrate to the world Canada’s contributions and to share what Canada is doing within its own borders to ensure fair and equitable maternity care for all Canadians.

Evidence from around the world demonstrates that midwives are essential to improving the lives of mothers and babies. Let us work together to ensure that in June of 2017, when midwives and health professionals from around the world gather in Toronto, that Canada is seen as a leader in the delivery of safe, equitable and cost-effective community-based maternal, newborn and child health services for all Canadians and continues to be a global leader in this area.

We applaud the government's Muskoka initiative and more recent global investments in maternal, newborn and child health that have helped to train midwives and skilled birth attendants, and increased women's access to quality midwifery services internationally.

The Canadian Association of Midwives continues to play an important role in ensuring Canadian expertise is being fully utilized to strengthen midwifery globally.

In closing, Canadian midwifery is a model of maternity care that provides excellent patient satisfaction, while decreasing rates of intervention and providing cost-effective care. This model is especially suited for providing care in rural and remote communities where transportation costs to transfer patients are staggeringly high.

Midwives benefit from flexibility and sustainability when they work to their fullest scope of practice, which is why this model should be explored and expanded by those looking for innovative models of care.

We are thrilled to be hosting the ICM global midwifery congress in Canada in 2017 and see this as an opportunity for Canada to shine even more on the global stage. Bill C-608 is an important step towards recognizing the growing profession of midwifery and the essential role midwives play in the delivery of maternity care and its potential to enhance our health care system across the country.

Thank you for the opportunity to appear before the committee and I look forward to any questions you may have.

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