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Results: 1 - 15 of 29
Ellen Blais
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Ellen Blais
2021-05-25 11:05
Thank you. Shekoli. Good morning.
I'm speaking to you today from Wasauksing First Nation near Parry Sound.
Thank you, committee members, and thank you, Madam Chair. I am honoured to have the opportunity to have a few minutes to share with you some words about the value of indigenous midwifery to the health and wellness of indigenous communities.
My name is Ellen Blais, and I hold the position of director of indigenous midwifery at the Association of Ontario Midwives. I am a graduate of the midwifery education program at Ryerson University, and I am from the Oneida Nation of the Thames.
I would like to share the name I was given that connects me to my spirit. In the Oneida language my name is Kanika Tsi Tsa, which means Little Flower. I was born through the waters of Many Flowers, who was born through the waters of She Who Carries Flowers, my maternal grandmother. My identity comes from a place of dislocation from the moment I was born, being taken away at birth by child welfare from my culture and my roots. The story of indigenous midwives is inherently related to dislocation as well, up to and including the closure of the Laurentian University midwifery education program.
Sadly, my story is shared by many. Although indigenous people make up about 4%-5% of the population of Canada, in many jurisdictions well above 60% of our population are in the care of the state. Since indigenous midwives are often present at the birth of indigenous babies, they work hard every day to intervene in these destructive practices and are providing excellent clinical care to every indigenous family they are working with. However, there are far too few of us to sustain this kind of work into the future.
I have three recommendations that I will now share, and then provide you with real-life contexts of why these recommendations are relevant.
First, we need a commitment from the federal government to build capacity for indigenous midwifery programs and services by developing a funding strategy to ensure indigenous midwifery is core funded.
Second, we need a commitment from the federal government to provide a mechanism to hire midwives and to provide housing and infrastructure for midwives in first nation and indigenous communities.
Third, we need a commitment from the federal government to provide funding for indigenous midwifery education, so that individual communities can support broader initiatives or create their own midwifery education programs that are relevant to the community, self-governed and community-responsive.
To connect the theme of dislocation, the history speaks for itself. The colonization of indigenous lands and resources also involved the forced removal of our children by the state to be placed in residential schools, now replaced by the current child welfare system. The medicalization of childbirth, along with policies embedded in the Indian Act, pushed indigenous midwives to the side and extinguished their work.
Without these overwhelming forces, midwives would have stood strong to keep birth in our communities. Midwives would have held our babies close and would never have allowed infants and children to be taken out of their mothers' arms. The anti-indigenous racism that is so prevalent in our health systems would not have been allowed to develop exponentially, to the point where indigenous people die from lack of culturally safe care.
In addition, the closure of Laurentian University has left a huge gap in providing midwifery education in the north, and with that, access for midwifery education for indigenous students and the growth of indigenous midwifery in northern communities.
Allow me one moment to ask you a few questions to illustrate my story.
If you have had children, imagine yourself when you were preparing for childbirth, or maybe even preparing for the birth of your grandchild. What were your hopes and dreams for your birth? Where were you going to have your baby? Most likely, you were thinking about your home, your family and your community.
Now replace your thoughts with these. Imagine yourself getting on a plane alone about four weeks before your baby is due. You wave goodbye to your family and hope that they will be okay. You arrive in a small rural or remote community thousands of kilometres away, where you know no one. You live in an unfamiliar place and you wait four lonely weeks until your baby is born. At birth, there is no family, no home and no community. You get back on a plane and you go home all alone with your baby in your arms, with no support.
This is what indigenous people have had to do for generations. It is a harmful and hurtful practice. Where is the sound of the newborn baby's cry? We have only silence. What does that mean for the health and wellness of your community? What has been lost?
In conclusion, access to indigenous midwives is imperative for the health outcomes of indigenous communities. Please consider these recommendations. We are tired of holding this up on our own. We know that to bring back birth is to bring back life. We know how to do this. We are strong, we know what we need, and we are brilliant.
I will conclude with a final ask by sharing a quote from the Women Deliver Indigenous Women's Pre-Conference.
We ask the government of Canada to measure the health and wellness of Indigenous women, girls and gender diverse people as an indicator of the health and wellness of the entire nation.
Thank you. Yaw?’kó
Josyane Giroux
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Josyane Giroux
2021-05-25 12:23
Thank you, Madam Chair.
Good afternoon, everyone.
I thank the committee for having me here today.
I am Josyane Giroux, a midwife and president of the Regroupement les Sages-femmes du Québec, or RSFQ.
The RSFQ is the professional association that represents more than 240 midwives working in the profession throughout the province. It works to develop the profession and its specificity within Quebec's health care system. In collaboration with the authorities and citizen groups, the RSFQ is committed to supporting access to midwifery services that meet the needs of the population.
The RSFQ also defends the free choice birthplace for women or people who give birth, in accordance with the standards of practice of the profession, as well as its philosophy of practice. The RSFQ is recognized by Quebec's department of health and social services as a spokesperson for midwives, and it negotiates their working conditions.
In Quebec, midwifery has been legally recognized since 1999. At the time, there were already six birth centres where 50 midwives worked. In 2008, the Quebec government published its perinatal policy, in which it pledged that, by 2018, midwifery services would be available in all regions of Quebec, that 10% of women and birth attendants could access services and that there would be a total of 20 birthing centres across the province.
According to 2019-20 data, only 4% of maternity follow-ups are carried out by midwives. Many regions still don't have access to services, and all the birthing centres have very long waiting lists, sometimes representing 30% of the number of annual follow-ups that can be offered by the teams.
We think there are three main reasons for this slow-motion development. First, the lack of recognition of the profession in general and its crucial role in reproductive and sexual health is a major issue. The midwifery model of practice, based on relational continuity, confidence in autonomy and respect for the physiological process of pregnancy and childbirth, is not recognized and valued.
In Quebec, the lack of knowledge of the profession heightens tensions and still leads to refusals of collaboration by medical teams. Ultimately, this remains an obstacle in the development of interdisciplinary services or projects that meet the needs of communities. The government has failed in its crucial role of demystifying and valuing the midwifery profession and its importance to the health system. On a day-to-day basis, it is midwives and families who are experiencing this pressure and are still fighting against misperceptions about their practice by clinical teams and the public.
The second major deficiency is the lack of workforce planning and workforce monitoring consistent with the objectives presented. Despite numerous representations in this regard by the RSFQ and other organizations, the warnings were not heard by the Quebec department of health social services. Midwives and families are the main victims of this lack of political leadership, as labour shortages are now affecting all midwives and forcing them to reduce services to the population. At this very moment, more than 20 contracts are unfilled in the province, and the opening of at least two birthing homes has been delayed.
In Quebec, the Université du Québec à Trois-Rivières is the only educational institution for the midwifery profession. It has a capacity of 24 students per year since the program opened in 1999, but is struggling to fill these places due to the lack of midwives to accompany trainees. It is essential that national consultation work involving the groups and community-based organizations directly involved, including citizen groups, be undertaken in order to find solutions and establish a clear plan.
The third very important element to consider in the analysis of the development of midwifery services and its slowness is the gender discrimination that midwives experience. The midwifery model, developed to meet the needs of women and pregnant persons and whose services are mainly aimed at women, is the source of indecent working conditions. Quebec midwives, at the end of their careers, earn 20% less than their comparable pay equity jobs. In Quebec, in 2019-20, the government paid only a total of $23,561,343 for midwifery services, including all operating costs. These working conditions, in addition to the context described above, lead to many early departures from the profession, exacerbating the shortage of human resources.
At the same time, the RSFQ operates solely based on membership dues, as the government does not recognize the importance of a strong professional association for supporting the development of the profession. Our association therefore struggles to meet all the needs, both those of its members in a global way and the support in the strategic work more than necessary.
Finally, it is with humility that I would like to add that the elements I've described are an exacerbated reality for women, pregnant people, and midwives from indigenous communities.
To date, there is no clear plan to provide families in these communities with access to midwifery services. Collaboration is at its starting point between governmental and legal organizations, communities, universities, and associations.
Our NACM colleagues and indigenous midwives will certainly be able to explain the issues in detail, but we believe it is crucial that the committee look at these matters.
In short, the RSFQ asks the provincial, territorial and federal governments to set up a campaign to demystify, promote and recognize the midwifery profession; invest in the establishment of a working committee for workforce and development planning in line with community needs; provide funding to professional midwifery associations, essential in supporting practice at all levels; recognize gender discrimination faced by midwives and adjust working conditions to end it; and prioritize work for the training, accessibility and development of midwifery services in indigenous communities.
Thank you, committee members, for your attention.
I will be happy to answer any questions you may have.
View Lindsay Mathyssen Profile
NDP (ON)
Thank you.
One of the things the Canadian government has a responsibility for doing is to enforce the Canada Health Act. Within that, of course, is reproductive services being available to women across Canada equally and fairly. Certainly the role of midwives has the ability to expand. For example, in Hamilton, Ontario, they are working with other doctors, ensuring that they have medications available so that women who need access to reproductive services can get them.
Can one of you, or all of you, quickly talk about expanding that role of midwives to ensure that women have that equal access under the Canada Health Act to reproductive services and health services?
Kirsty Bourret
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Kirsty Bourret
2021-05-10 19:27
I have to jump in and speak here, because this is an area of interest of mine.
It's important to point out that it actually isn't an expansion of our role. In Ontario it is, but when you look at our global definition of midwifery, we have it within our scope to provide all sexual and reproductive health care, which includes contraception, which includes access to abortion. This is something that's well known and that we are trained to do.
Again, around the world, I am working with Global Affairs Canada to ensure that midwives have the capacity to do this within their scope, which means increasing access to sexual and reproductive health care, especially in very, very remote and rural areas. We've been arguing for that for a really long time. While in Ontario it might look like an expanded scope, really the vision of midwifery at the national level is to be able to provide these services across Canada.
You know, this will have a huge impact on our ability to impact this issue around our overall lack of access to contraceptive and reproductive health care, especially with indigenous and other populations that are at a disadvantage. I think there is an opportunity here to have this discussion and to raise awareness of midwives' capacity to function in that way.
View Anju Dhillon Profile
Lib. (QC)
My God.
Ms. Bacon, I have a question for you.
You've done considerable work in sexual health education. Can you share with us how midwifery services support the provision of sexual and reproductive health care in Canada?
Alixandra Bacon
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Alixandra Bacon
2021-05-10 19:55
Thank you so much.
This is an area where midwifery is greatly underutilized, as Dr. Bourret alluded to earlier.
It is within the scope of a midwife to provide cervical cancer screening, to be providing contraception, including the placement of intrauterine devices and the new Implanon contraceptive insert. It's in our scope of practice to be testing and treating for sexually transmitted and blood-borne infections.
However, in some jurisdictions, this is with an advanced scope of training. It is not accepted in all jurisdictions. There are also constraints, in that we are limited to providing this care, in most cases, though not all, to people who are pregnant or in the first three months postpartum.
This is an area where midwives could be providing a much larger role and having a bigger impact in helping to meet that unmet need for contraception in Canada, for long-acting, reversible contraception in particular, and that culturally safe component of care.
There are pilot projects, in Ontario in particular, such as the MATCH program, where midwives are working with delegation of function to be able to provide these services to people outside of that child-bearing year, as well as to provide abortion services. These are areas where we can expand.
View Jag Sahota Profile
CPC (AB)
You both spoke about this, but I think it was more Ms. Bacon who spoke about the C-sections and hospitalization admissions being low when there are midwives involved. What are some of the contributing factors for that ? That's actually quite interesting.
Kim Campbell
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Kim Campbell
2021-05-10 20:12
You bet. It is my wheelhouse. That's the evidence-informed practice for midwifery care.
We have evidence that supports the fact that the role of the midwife contributes to several decreases in interventions, caesarean sections being one of them. We think it's the continuity of care. We think it's the relationships we build and the trust and the comfort that people have when they're with someone they know. It's quite simple: It lets their body do the work. Anxiety stops that, so when you create a soft landing spot and a safe place for people, the body does what it needs to do. It's very simple. That's it.
Alixandra Bacon
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Alixandra Bacon
2021-05-10 20:12
I would add that midwives picture birth as a normal life event. We do not pathologize birth. Also, we've learned the art of watchful waiting.
There's the cliché of midwives knitting in the corner, but it's for a very good reason. If we're knitting, we're not intervening needlessly. I think that's a real unique midwifery skill set that contributes to the decreased caesarean rates, as well as the time with our clients to make sure they're really well informed and prepared for what to expect in a birthing process.
Also, they have that continuous support in labour. We don't just sweep in at the end and catch a baby. We are with them from the onset of active labour until an hour or two after they birth, and that means that sometimes I might spend 14 hours straight with someone in supporting them. I believe it's that quality time that we spend one-on-one that makes the difference.
View Jag Sahota Profile
CPC (AB)
You've just said that you can spend up to 14 hours with someone. Do you come up with specific solutions for the clients depending on their needs and accommodate them? Let's say they're a high-risk client. Does the care start earlier than it does for others and end later as well? How is that managed?
Kim Campbell
View Kim Campbell Profile
Kim Campbell
2021-05-10 20:14
I can jump in a bit here.
We have a system of risk assessment and we make sure that we individualize the care to meet the risk and the needs of the person. We always have our antennae up. We're always checking the environment. We're always situationally aware, and we pivot constantly.
View Lindsay Mathyssen Profile
NDP (ON)
Thank you.
I just wanted to use my final time on postpartum care. You've touched on it a bit but we haven't heard a significant amount about your postpartum care and what that means to women and the services that are provided—the difference in care that it provides.
Alixandra Bacon
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Alixandra Bacon
2021-05-10 20:22
I think you see Kim and me smiling because you have touched on what is perhaps the biggest selling feature of midwifery care. We look after birthers and their babies until approximately six weeks postpartum—or at least we're compensated in my jurisdiction to six weeks, and care for them of up to 12 weeks, so there is that continuity of care. In the first week postpartum, those visits happen in the house. We do not expect you to pack yourself and your new baby into the car and drive to our office at five days postpartum, and we're coming the very next day. We will see you each day that you're in hospital, if you are in hospital, until you are discharged, and your very first day after discharge we're coming to you at home.
I can tell you both as a midwife and as a mother that if you are hoping to breastfeed, it is not as easy as it looks. It is extremely difficult, and your success is dependent upon receiving care early on. If I had had to wait until day five postpartum, my son would not have been fully breastfed or perhaps been a child who was not breastfed at all.
That is a place where our care really shines. It's also where we really have an opportunity to impact families as a whole in recognizing and responding, for example, to family-based violence or child neglect. We are very privileged to be able to enter people's homes and it really deepens the trusting relationship and is one of the most beautiful and heartfelt parts of our work.
View Lindsay Mathyssen Profile
NDP (ON)
Thank you, Madam Chair.
We heard in this panel and the last, as well, about the importance of the relationship that women have with their midwives, and that is a special relationship because it is fully about trust. Delivering in the best of situations is very stressful—not that I've done this yet but so I've been told by many friends.
To have services in your own language, to be able to be serviced in ways that are culturally appropriate and culturally sensitive.... Could the witnesses talk about the importance of that, in addition to—and I know that Ms. Recollet and Ms. Wolfe are in more of an urban centre—the special needs for northern remote, as you also mentioned before, communities and women having access to those culturally sensitive, traditional knowledge-based practices with indigenous or aboriginal midwives?
Angela Recollet
View Angela Recollet Profile
Angela Recollet
2021-05-06 12:42
We're not just going to talk about Ontario and Quebec. We need to talk about what you now call Canada as a whole.
I'll give you an example. With the Inuit nation, those mothers, those expectant mothers, have to be displaced from their communities and their families, with only one individual to accompany them as a support system, and have to travel hours and hours, sometimes 40 hours, in order to get to a nursing station to have a non-Inuit or non-native practitioner provide care that is unsafe, lacking cultural bias to their birthing right. That in itself has to be recognized. A solution-based policy would be to provide access in our traditional territories. We do not want to be displaced anymore, and that goes from coast to coast to coast when it comes to our circle of life.
Even here in an urban setting, as you're asking, it wasn't by choice that we were located to urban settings, but I can say that 80% of the indigenous population in what we now call Canada has been displaced to urban settings so that they can have the same access to care that all of you on this call have.
We continue to have to fight for this, to reclaim who we are as indigenous people in these first territories with limited access to resources and constantly needing to justify why we require it. Right from birth to death, this is our ongoing struggle and our ongoing education that we need to provide to newcomers, to government officials, to everyday people walking down the street, to break down what you've learned and provide you with a different education so you know the true history in Canada.
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