ON Chiropractic Spring/Summer 2013 - Page 21

ON Chiropractic FEATURE STORY / FROM MARGINAL TO MAINSTREAM Later, transplanted European midwives played a role in the expansion of the settlements that became Canada. But, by the early 20th century, the practice of midwifery in most parts of the country was illegal. It was not until the 1980s that midwifery re-emerged in its modern form. Since then, the profession has experienced a substantial expansion of the role it plays in the Ontario health care system. This prompts one to ask how Ontario’s midwives were able to travel the distance from their practice being illegal to their current role in just a few decades. One might also ask what chiropractic can learn from the evolution of midwifery, as this profession endeavours to be recognized as the spinal health care experts in the province’s health care system. The same way that midwives are the province’s expert primary care providers in what is known as “normal” or low risk birth, chiropractors have the training and expertise to be Ontario’s primary musculoskeletal care providers. L ike chiropractic, midwifery has evolved over time. In Canada, the government sanctioned practice of midwifery pre-dates Confederation by almost 200 years. In 1691, the government of New France, now Quebec, established three autonomous branches of medicine: physicians, surgeons and midwives. From 1755-1764 the government of England compensated British midwives who settled in Nova Scotia. As late as 1843, municipal officials in Quebec were granting midwifery licences. It was when the Medical Council of Canada formed in 1912 that the practice of midwifery was marginalized and then criminalized in most parts of Canada. Quebec rescinded the certifications of the province’s midwives in 1944. This began a long period when obstetricians were responsible for essentially all pregnant women and births in Canada. Some midwives continued to practice in secret, predominantly in rural areas. But, with training no longer readily available, midwifery all but disappeared along with the choice of care provider that midwives presented Canadian women. The resurgence of the practice began in the 1970s. Of the various preconditions to the resurgence of midwifery, one stands out. The modern feminist movement in North America empowered women to think, act and speak as individuals. The Ontario Nurse Midwives Association was founded in 1973, though the practice of midwifery remained illegal. The Charter of Rights and Freedoms came into effect in 1982. By the beginning of the 1980s midwives were secretly practicing in greater numbers. Some of those women were inspired to become midwives when their own children were born. Dissatisfied with the standard care of the time, women began attending births and learning everything they could about the practice of midwifery. As the practice was still illegal, training was cobbled together from textbooks, conferences and sympathetic doctors. Some apprenticeships and international training opportunities were available. Of course, each birth they attended was a significant risk. In 1983, an ambulance had to be called when complications necessitated the movement of a woman under the care of a midwife to a hospital. The midwife hid her medications in a bathtub and was prepared to be arrested for practicing medicine without a licence. It was in 1986 that the Ontario Government recognized the role that midwives might play in the province’s health care system. In 1987, the Report of the Task Force on the Implementation of Midwifery in Ontario was published and established the regulatory framework of the profession. Two years later the Interim Regulatory Council on Midwifery was established. That council’s work culminated in the Royal Assent of Bill 56, An Act Respecting the Regulation of the Profession of Midwifery. Within two years of the passage of Bill 56 three Ontario universities established undergraduate degrees in Midwifery. Then in 1994 the passage of the Midwifery Act designated midwives as regulated health professionals under the Regulated Health Professions Act. L isa Weston was a midwifery client in the early days of the profession’s most recent regulation. Today she is a midwife practicing in the eastern MIDWIFERY TIMELINE 1691 1755 1764 1861 EARLY HISTORY Midwifery recognized as an autonomous branch of medicine in New France (Quebec) 20 British government compensates British midwives who settle in Nova Scotia SPRING/SUMMER 2013 Medical Council of Canada eliminates midwifery in most of Canada Midwifery certificates repealed in Quebec CRIMINALIZATION Florence Nightingale opens Kings College Hospital School for Midwives 1912 1944 1976 1986 1987 1989 1991 MODERN RESURGENCE World Health Organization declares support for midwifery Ontario Government announces intention to establish midwifery as a recognized part of the Ontario health care system Laurentian, McMaster, and Ryerson begin offering underunder graduate degree programs in midwifery GTA and Durham Region. She is also the President of the Association of Ontario Midwives. When she was asked to recount those exciting and fateful days in the late 1980s and early 1990s, she first thinks of the consumer demand that played a pivotal role in securing support for midwifery at Queen’s Park. “Midwives were called to serve by their community,” she said. “Consumers had a very loud voice in saying what about midwifery worked for them.” Combined with the views of midwives, this input from the consumers of midwifery played a pivotal role in the establishment of the core values that govern the profession to this day. “Midwives and clients together were very clear about the vision that they had for midwifery,” Weston explained. The core values of midwives are contained in what are called the three pillars of midwifery care. The first is Ontario Midwifery Act comes into effect, formally designating midwifery as a regulated health profession in Ontario Aboriginal Midwifery training programs begins operation at Tsi Non:we Ionnakeratstha Ona:grahsta on the Six Nations Territory in Ohsweken, Ontario HEALTH SYSTEM INTEGRATION Ontario publishes Report of the Task Force on the Implementation of Midwifery in Ontario Canadian Confederation of Midwives is constituted Ontario Government creates Interim Regulatory Council on Midwifery. Bill 56, An Act respecting the regulation of the Profession of Midwifery, receives Royal Assent 1993 1994 2000 2012 Ontario announces funding for two midwifery-led birth centres www.chiropractic.on.ca 21