My last midwife appointment was more than four years ago, and I still remember the feeling of sadness that settled in me as I walked away from the office after being discharged. Because midwives continue to see you and your newborn for six weeks postpartum, there is a tremendous bond formed between new parent and midwife. I can still picture my cat settling in to the lid of my midwife’s physician bag, as she began a postnatal home visit, and my midwife laughing. She had become like family.
When I was pregnant with my first baby, I chose a midwife because I loved the idea of having support during the postpartum period. I was desperately afraid I wouldn’t be able to breastfeed. When that fear turned into reality and my daughter was unable to latch, my midwife spent countless hours working with me to find feeding solutions I was comfortable with. She rubbed my back as I sobbed and expressed my feelings of failure, and then walked me through finger feeding, cup feeding and using a nipple shield. She taught me how to transition from the nipple shield to directly breastfeeding, and during my final appointment, she shouted with joy as she watched my baby latch directly onto my breast.
So when I heard, last week, that the Ontario Ministry of Health and Long-Term Care, under Premier Doug Ford, had eliminated all provincial funding for the College of Midwives of Ontario, my first reaction was anger. Anger, but not surprise.
Amid the online outrage, it was hard to get the facts straight. No, the government has not (yet) eliminated OHIP coverage for midwifery (thank goodness). You can still choose to deliver your baby with a midwife, if you have access in your community. In fact, 15 percent of women in Ontario choose midwifery care. But Ford’s government is retroactively withdrawing provincial funding for the College of Midwives of Ontario, the regulator of the profession.
This governing body is responsible for accreditation and ensuring that all midwives in the province adhere to the same high standards. They’re the ones who create policies, procedures, and assessments to make sure midwives are giving the highest quality care possible.
It was the only regulatory college with public funding, which they received due to their small membership numbers when the College of Midwives of Ontario was first established in 1994. Back then, there were only 60 members, but they were expected to perform the same regulatory functions as larger health colleges. The annual provincial funding, which the College had counted on for 25 years, helped make up the difference. For a college like the College of Midwives, or the College of Physicians and Surgeons of Ontario, membership fees cover operational costs. When you have fewer than 1,000 midwives, versus tens of thousands of physicians, the discrepancy becomes clearer. The cost passed along to midwives—in the form of increased membership dues—will be considerably higher than if it were distributed among the members of another college with a higher membership.
Victoria Marshall, a communications officer with the College of Midwives of Ontario, says that the changes will not affect their operations in any way—the quality of midwife care, and the safety of Ontario mothers and babies, is not under threat.
But Sarilyn Zimmerman, the semi-retired Toronto midwife who delivered both of my babies, was more outspoken in her response.
“It’s one more contemptuous insult in a long line of cuts—devaluing midwives, women, children, schools and programs for special needs,” she wrote to me.
It was Zimmerman who coached me during my breastfeeding troubles with my daughter, and it was Zimmerman who noticed, during my second pregnancy, that I was acting differently than she remembered with my first baby. Before I had even begun to admit to myself that something was wrong, she was pre-screening me for prenatal depression and referring me to Women’s College Hospital, where I was treated for perinatal depression, anxiety and OCD. I have no doubt that early intervention saved my family and me in more ways than one, and it's one reason why I'm such a strong advocate for the midwife profession.
There are approximately 940 midwives in Ontario, and they’re already overworked and underpaid, especially considering the long hours and the 24/7 on-call nature of their profession. In fact, the current compensation ratio of midwife to physician is just 53 percent—meaning that a midwife makes half the salary a physician makes.
Ontario midwives have been fighting for fair pay for five years. In September 2018 they won a huge victory: the Ontario Human Rights Tribunal ruled the provincial government had to financially compensate midwives for years of gender-based pay equity discrimination. But Doug Ford’s government has so far refused to come to the table with the College of Midwives of Ontario to negotiate that compensation.
Sky Dasey, a midwife with Genesis Midwives in Kitchener, Ont., says that the refusal to negotiate compensation, while also retroactively taking away funding from the College, are just two ways the government is withdrawing support for practising midwives. “They’re not willing to compensate us at a level that would allow us to pay fees that would make us autonomous,” says Dasey. “At the same time, they’re capping the number of midwives [in] and the amount of growth we can have. It feels like an affront to women’s health.”
A spokesperson for the Minister insists we don’t need to worry about the future of midwifery. “Our government values the contributions of Ontario’s midwives and the care they provide to expectant families, and will continue to listen to patients and the people who plan and work on the front lines of our health care system.”
If that’s the case, then why isn’t the Ministry concerned about getting equal pay for our midwives? Premier Ford, your government says it cares, but the optics aren’t great. We’ve also seen Arts Council cuts, at-risk youth cuts, indigenous culture funding reduced, and education projects cancelled—it’s not hard to see a disturbing trend here.
Thankfully, the College of Midwives of Ontario will work hard to make sure their patients aren’t impacted by their budget shortfalls. But it’s still a concerning development for women in this province. The public outcry following the news is an indicator of how worried—and fearful—we are about the Ford government’s endgame, and what else they might cut next.