Association of Ontario Midwives Summer 2012

AOM Conference and Annual General Meeting
Strength in numbers: supporting the growth of midwifery
When Minister of Health and Long-Term
Care Deb Matthews stopped by
the Annual General Meeting and
Conference closing ceremonies to
announce funding for a practice in
Attawapiskat, the crowd responded
with a standing ovation. Funding
a practice for a remote Aboriginal
community in great need garnered an
emotional reaction from members.
This continued
support for the
growth of midwifery
is key as the
first class of the
expanded Midwifery
Education Program
(MEP) graduates
this spring. The
MEP now enrolls 90 Elizabeth Brandeis, RM
new students each
AOM vice-president
year at the three
sites combined,
compared with 60
prior to 2008. There are more than 600
midwives currently practicing in Ontario
and by 2015 it is anticipated there will
be more than 1,000.
This year’s conference theme, Strength
in Numbers, Supporting the Growth
of Midwifery, addressed the need
for careful thought about shaping a
growing profession and addressing the
challenges inherent to that growth.
Conference presenter and assistant
dean of midwifery at McMaster
University Eileen Hutton says the
larger number of students has created
a challenge with regard to physical
space for clinical placements.
“When we were starting out, practices
were new, underutilized, there was lots of
space,” Hutton says. “Now practices have
more midwives but they haven’t changed
space . . . so even if the birth capacity is
there, the space availability isn’t.”
Finding non-midwifery clinical placements
is also proving to be difficult as
other health education programs are
also looking to grow their professions.
“We have more students, but the
medical programs have also grown
quite a lot . . . so there is direct competition
for spots,” Hutton says.
Fundamental changes both within
the profession and beyond will
have to be explored to help address
the changing needs of a growing
profession, Hutton says.
“Having our own standards allow us to
advocate on behalf of our clients who
may choose care that may not be reflected
in other professional guidelines yet is
evidence-based, reasonable and safe.”
Universities may need to work with
hospitals to change how placements
work; Hutton suggested a “package
deal” where hospitals who want
medical residents
also get midwifery
students, nursing
students and
physiotherapy
students, among
others.
As the profession
grows, some
hospitals are
capping the
number of
midwives
practicing there.
Hospitals and
health care providers need to work
together to find solutions to support
the growth of midwifery. For example,
having OBs on salary would enable
midwives to attend increasing
numbers of low-risk births, Hutton
suggested.
Association of Ontario Midwives
vice-president Elizabeth Brandeis’s
conference panel presentation focused
on how a greater understanding is
needed of both the similarities and
differences between the midwifery
model and care provided by obstetricians
and other providers.
“It’s important to establish where
common ground exists,” she says.
“Working in interprofessional groups
like MoreOB and labour and delivery
committees allows midwives to
interact on a more personal level
with leaders in the hospital and
set the tone for understanding the
foundation on which differences may
exist and when common standards
are appropriate.”
She noted that advocating for midwifery
community standards is an essential
part of growing a strong profession.
“If we don’t have our own midwifery
community standards, we are forced
to conform to other established
standards,” she says. “Having our own
standards allows us to advocate on
behalf of our clients who may choose
care that may not be reflected in other
professional guidelines yet is evidencebased,
reasonable and safe.”
Advocating for midwifery standards
in a hospital setting and educating
other professionals about midwifery is
critical. Brandeis says midwives should
initiate conversation via planning a
rounds or presenting to a committee.
Using tools such as clinical practice
guidelines (CPG) can depersonalize
conflict and show hospital colleagues
that midwives are part of a wellinformed
professional community.
“Our clients come to us with the
expectation that their choices will be
respected and supported. CPGs provide
a framework for us to inform and
support our clients in a range of diverse
choices,” she says. “When the conversation
is about the client and supporting
her autonomy and choice, the issues can
move away from ‘us vs. them’ and focus
on client-centred, evidence-based care
that supports normal birth.”
Providing support toward the kind of
research that informs tools such as the
CPGs is an important next step in moving
midwifery forward, Hutton says. Though
other professions can tap into dedicated
pockets of funding, such as hospital
competitions, midwives have few
funding streams to support research.
“In the last 20 years we’ve focused
on building a very strong education
program and strong practices . . . and
we are getting to a size where we can
put money into (research),” Hutton
says. “Practice didn’t evolve without
lots of support, and I think research is
no different.”
One of the benefits of expanding
the MEP and growing the number
of midwives is that strength really
does come in numbers. Now more
than ever, midwives can capitalize
on opportunities for creating new
practices, improving hospital
relations, and advocating for
dedicated research funds.
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ontario midwife • Summer 2012