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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;" http://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 (http://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 Kanácí Otinawáwasowin (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, Métis 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
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