Canada: 'closer to the goal of regulated midwifery across the country': Canadian midwives Kerstin Martin and Rosalind Lydiate provide an update on midwifery regulation in the provinces of Canada.

Kerstin Martin, RM, MA, President, Canadian Association of Midwives/Association Canadienne des sages-femmes, reported to ICM:

In the majority of Canadian provinces and territories today, the regulation and integration of midwives in the health care system is either established or underway. The western prairie province of Saskatchewan recently proclaimed its Midwifery Act in March 2008; Nova Scotia on the Atlantic coast has also passed legislation and expects to implement midwifery in 2008--bringing us closer to the goal of regulated midwifery all across the country. Considering that midwives were not legally recognised anywhere in Canada only 20 years ago, these developments represent tremendous and rapid change.

Saskatchewan midwives (and women) are delighted with these developments and look forward to the day when midwifery services will be available across the province.

Membership in the Canadian Association of Midwives (CAM), including students, now stands at 800--an increase of 50% within the last three years. In a country as vast as ours, however, these numbers are still very small. In many communities there are no midwives at all; in others midwives are so much in demand that 40% of women have to be turned away. With the exodus of family physicians from the field, primary maternity care is increasingly delivered by obstetricians (84% of all births in Ontario). Fewer than 10% of births in Canada are attended by midwives; home births constitute only 1-2%. The need for more midwives, especially in rural, remote and Aboriginal communities, is acute.

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The regulatory, educational and systemic challenges of building the midwifery profession in Canada are immense, but so are the opportunities.

This last year alone, we have seen increased government funding to expand the capacity of university midwifery education programs in Ontario; federal government support for the development of midwifery policy and a national database; discussions about reciprocal accelerated educational tracks for nurses and midwives; the launch of a national registration exam; preparation of a multi-jurisdictional bridging program for internationally-trained midwives; and ground-breaking work by First Nations, Metis and Inuit midwives to create a national Aboriginal midwifery organisation under the CAM umbrella.

Midwifery in Canada continues to be an exciting and deeply rewarding profession as it gradually assumes a more central place in maternity care. We look forward with great pleasure to sharing our experiences and learning from yours when we meet in Glasgow!

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Rosalind Lydiate, President of the Midwives Association of Saskatchewan, added:

The Legislation to regulate Midwifery in Saskatchewan was finally proclaimed and became law on 14 March 2008. Members of the Midwives Association of Saskatchewan attended the legislature for the proclamation and afterwards talked to the press. Midwives will be employed by local Health Regions and will be funded by the provincial government. The legislative framework also allows for private practice but independent midwives will not be publicly funded at this time. Initial implementation will consist of four midwives in Regina and four in Saskatoon, with their practice restricted to city limits.

'We are delighted to see midwifery moving forward in our Province. These developments will increase access to midwifery care for the families of Saskatoon and Regina and we look forward to the future when midwifery will be available to the entire Province.'

Local newspaper, the Prince Albert Daily Herald, said:

'We applaud the government's initiative in creating a legalized and established midwifery profession in the province of Saskatchewan.

' ... The benefits of establishing midwives as an entrenched part of our health-care system cannot be understated.

'Studies from around the world, including the World Health Organization (WHO), show that suitable pre-natal care and labour support is a vital tool in ensuring healthy outcomes for both mother and child, especially in terms of reducing the chances of a caesarian delivery: a painful and cost-intensive surgical procedure.... The costs of a caesarian birth are dramatically greater than a natural home birth and midwives are statistically proven to reduce surgical interventions of all varieties....

'Ultimately, the government's move will not only benefit women and children, but the taxpayer as well'.