The Ontario government released its 2017 budget yesterday, which spoke to the Liberals' commitment to continue making midwifery care accessible to Ontarians.

The budget specifically noted that "midwifery services provide low-risk birthing options to improve the quality of care and value for Ontarians" and the government’s commitment to ensure that "families with low-risk births will have increased choices for quality care, reducing the need for more costly hospital or specialized care.”

Specifically, these commitments are supported by investments that will enable the sector to increase by up to 90 new midwives this year.

The budget highlighted the Liberal commitment to Aboriginal midwifery and supporting culturally appropriate care, including funding for care provided by:

• Dilico Family Health Team Clinic in Fort William First Nation
• K'Tigaaning Midwives in Powassan
• Kenhte:ke Midwives in Tyendinaga Mohawk Territory
• Onkwehon:we Midwives in Akwesasne
• Shkagamik-Kwe Health Centre in Sudbury
• Southwest Ontario Aboriginal Health Access Centre in London

Along with these investments, the government is also providing development grants to Indigenous communities across the province who are exploring the renewal and restoration of midwifery in their communities.

There was no commitment in the budget to address the gender pay gap for midwives in Ontario. However, we continue to move forward with our case at the Human Rights Tribunal of Ontario. Closing arguments for the case will be heard by the Tribunal on June 8 and 9 – mark your calendars, all are welcome to attend.

Toronto-area families are celebrating one big milestone today: since opening its doors in January 2014, the Toronto Birth Centre has been the birthplace for 1,000 babies, all caught by midwives.

I had the pleasure and privilege of attending the very first birth at the Toronto Birth Centre, a beautiful water birth in the Cedar room. Every birth is extraordinary, but this one felt extra special. The parents were excited and thrilled to be part of the momentous occasion; and, as midwives, we knew we had participated in a truly historic event.

I was still floating on a wave of elation when I attended a meeting immediately after the birth with midwifery stakeholders from the Ministry of Health and Long-Term Care, the College of Midwives of Ontario, and the Midwifery Education Program. Everyone in attendance at the meeting was eager and excited to hear about the experience.

I remember telling them that while midwives are accustomed to meeting clients’ needs in whatever ways we can, in whatever space we’re in, the birth centre facilitates that philosophy. At hospital births, you can hold space for your clients within the room, but outside of the room, all types of activities are going on—not always positive.

The birth centre is a joyful and focused place, with every detail designed by midwives for clients to experience birth as a normal life event. Both inside and outside of the birthing rooms, the space is welcoming to the labouring client, their chosen support people and the midwives and students. From the large community kitchen, to the beautiful and symbolic murals by Christi Belcourt in each of the rooms, to the accessibility of birth balls and slings and tubs, the birth centre sends the message, “birth is normal,” “birth happens here.”

The Toronto Birth Centre is dedicated to providing a culturally safe space for Indigenous families and families from all communities to give birth. This community-based, midwife-led centre located in the heart of downtown Toronto is the realization of a vision and the commitment of Seventh Generation Midwives Toronto. It had the backing of countless midwives and supporters who dreamed of this centre and those who worked tirelessly to make it a bricks and mortar reality.

When the Ministry of Health and Long-Term Care announced that it would fund the TBC and the Ottawa Birth and Wellness Centre, someone coined the wonderful phrase “now normal birth has an address.” It’s located on busy street, in a diverse, residential neighbourhood and the sign is obvious to anyone who passes by. I imagine the day when a child walking home from school with friends will point to the TBC and say “I was born there.”

The Toronto Birth Centre has literally put normal birth on the ground floor; this visibility is one way the birth centre has the potential to powerfully shift the way our society views birth. Each of the 1,000 births that has happened there, and all of the thousands to come, are also part of this shift.

Elizabeth Brandeis, RM, President

South of the border, Trump’s attack on women and on reproductive rights has sparked outrage and re-energized feminist movements. The world witnessed as crowds gathered across the U.S. and the world – including 60,000 in Toronto – to resist the assault on women’s rights.

Reproductive justice is at the core of this mobilization. Reproductive justice speaks to the feminist tenet that no laws should restrict the ability to access reproductive health services; birth control; STI/HIV/AIDS testing, care and prevention; sex education; and, of course, access to safe and legal abortion.

Attacks on reproductive rights take many forms, including legislative. But legal rights must also be backed by access – by people being able to experience these rights in their lived realities. It’s at this junction that midwifery steps in as a conduit of reproductive justice.

In Canada, calls for abortion access and care with dignity during pregnancy and birth were taken up by the feminist movement. Just a little over two decades ago, the profession of midwifery became a part of our universal health-care system, which has meant that people have been able to access midwifery care free of charge and in accordance with a philosophy that respects the pregnant person as the central decision-maker. In many jurisdictions (but not in Ontario, not yet anyway) midwives also perform abortions.

Choice is at the very heart of midwifery care. And midwives, as front line health providers, actualize and advocate for people’s right to choice. A midwife will follow a person to home, birth centre or hospital, depending on where they want to give birth, and provide the same level of excellent clinical care regardless of setting. Through the partnership and informed choice midwives provide (two concepts deeply rooted in feminist principles), midwives are champions of reproductive justice, their pagers the beacons that call them to the side of a person who has miscarried, a person in labour, a person struggling to move into the space of caring and feeding a newborn for the first time and, in some jurisdictions, a person who has chosen to terminate a pregnancy.

Midwives worked without an increase to their compensation from the day they were brought into Ontario's health-care system in 1994 until 2005. They not only cared for clients and their growing families, but they built a profession too. And over these 11 years, a gender pay gap grew. The pay equity analysis used in 1994 to ensure fairness for a female-dominated profession was not maintained by government. Over the years, this gap continued to grow. According to the Equal Pay Coalition, the pay equity gap between men and women in Ontario stands at an alarming 30%. For midwives, the gap widens to 48%.

Three gender-dynamics have played into the devaluing and deep discounting of midwifery work: midwifery is a female-dominated profession; those receiving midwifery care are women and trans people; and midwifery responds to a health event that is physically rooted in the bodies of women and trans people. These dynamics have made midwives the victims of a gender penalty. These dynamics have led midwives to a fight against systemic gender-based discrimination at the Human Rights Tribunal of Ontario.

Midwives have always been on the front lines, defending against attacks on reproductive rights and gender-based discrimination. That’s why this weekend, for International Women's Day, midwives will be marching for reproductive justice, midwifery and pay equity.

Elizabeth Brandeis, RM
President

For more than half of my career as a midwife, I’ve been part of the AOM Board of Directors. Over the last eight years, I’ve moved from Member at Large to Vice-President and now President. Being part of the board has been a rewarding journey. I’ve had the opportunity to participate in problem-solving and negotiations with the Ministry of Health. I’ve had the pleasure of meeting midwives from across the province and learning about the variety of challenges we face, the ways we are working to bring about change in our communities, and the role the AOM plays in supporting midwives and advocating for positive system-level changes. I do this work because I believe that midwives and midwifery make the world a better place.

I’ve collaborated with my board colleagues to discuss, debate and make decisions about the most strategic directions in which to steer our association and our profession.

While the board does its best to hear and represent the needs of midwives across the province, the reality is that midwives across Ontario are a diverse group that have very different experiences, challenges and needs. Midwives’ working conditions vary based on their scopes of practice, call-models and communities’ needs. Midwives work in a variety of settings: from birth centres, to communities with high home-birth rates; from the largest, urban hospitals, to small, level 1 hospitals, and with vastly diverse client populations. Midwives bring a wide array of their own lived experiences to this complex and challenging work.

All this is to say: the best way to ensure that a diversity of perspectives are heard is to have our members participate in the process. We need you to get involved!

I’m encouraging all AOM members to consider running for the Board of Directors. Whether you are in your first years of practice or have been at this for decades, we need your input! This year, we’re seeking nominations for a variety of roles, including Vice-President, Secretary and several regional coordinators. Read more about the roles and the nomination process on the members-only website.

The board is seeking courageous and compassionate leaders who are able to engage in critical and visionary thinking. The board has identified that it would be helpful to have members who have knowledge and skills in the following areas:

- Health systems and health policy
- Health care economics and hospital funding formulas
- Labour negotiations

Help us ensure that our board features a diversity of voices that represents members from across our profession. The board especially encourages Indigenous, racialized and queer-identified midwives to put their names forward.

If you’re interested in running for a position, but not sure if you’re ready to make a commitment, you can take advantage of a new mentorship initiative we’re introducing this year where we’ll pair you with someone to answer your questions.

Board nominations are being submitted this year via online form and are due Feb. 2, 2017 at 5 p.m.

I hope that you are inspired to become a member of the AOM Board.

Elizabeth Brandeis, RM, President

Representatives from the AOM and midwife Devi Krieger from the Midwives Collective of Toronto were at Queen’s Park on November 29 as members of provincial parliament (MPPs) voted on Bill 28, the All Families Are Equal Act, 2016. Since MPPs passed the bill, midwives and families across Ontario have been celebrating the new provincial legislation that will ensure equal treatment for all parents and children.

Bill 28 “recognizes the legal status of all parents, whether they are LGBTQ+ or straight, and whether their children were conceived with or without assistance.” Using gender-neutral language, the legislative changes will revise Ontario’s parentage and birth registration rules, amending laws, which have not been updated since 1978.


Midwife Devi Krieger (left) celebrates the passing of Bill 28, the All Families Are Equal Act, 2016, with Cheri DiNovo, NDP LGBTQ Issues Critic and MPP for Parkdale-High Park. Ms. DiNovo introduced an earlier version of the bill, named Cy and Ruby's Act, giving parental recognition to LGBTQ parents.

The LGBTQ Parenting Network, a program of Sherbourne Health Centre in Toronto, has been a champion of Bill 28. According to the network, the new legislation will recognize the legal status of all families by bringing about the following changes:

• There will no longer be a distinction between types of parents. A parent who gives birth will not have more legal rights than a parent who did not give birth.

• Sperm donors are recognized as donors, not parents.

• Multiparent families will no longer need to go to court in order to recognize up to four parents from birth.

• The legislation is written in language that recognizes a range of gender identities.

• A court process will no longer be required to recognize parents through surrogacy. When there is a surrogacy agreement in place, and all parents and the gestational carrier or surrogate agree, the surrogate will sign consent after the baby is at least seven days old, and the parent or parents will be able to register the birth.

The Ontario Hospital Association has drafted an update on Bill 28 for hospitals, as the bill may impact existing process and policies for the management of obstetric patients, specifically with respect to registration of births and understanding who has substitute decision-making authority as a parent of the child.

Midwives have long cared for diverse clients, including LGBTQ+ families and women who are acting as surrogates for families. This new legislation and new recognition of families will influence the way midwives fill out the provincial Notice of Live Birth form (which is completed by health-care professionals and sent to the Office of the Registrar General) and the way they counsel LGBTQ families and those who used assisted reproduction regarding the completion of birth registrations and certificates.

The United Nations International Day of Persons with Disabilities is celebrated annually on December 3. The AOM would like to honour the resilience of all those who are living with disabilities by sharing the story of one Ontario midwife who has found that working with a disability has given her new perspectives on the care she provides and opened new doors to helping others.

Midwife Mhairi Colgate remembers the moment she became acutely aware that her hearing loss had begun to impede her clinical skills. She was in the operating room with a client and other members of the health-care team. Her colleagues were wearing masks that muffled their voices and because she couldn’t see their lips, Colgate couldn’t understand what they were saying. She had a moment of panic, realizing that if someone asked for her help, she may not hear them clearly enough to follow their directions. She knew it was time to get hearing aids.

Colgate has lived with hearing loss, a side effect of a spinal tap she had as an infant, since she was very young. It’s gotten progressively worse over the decade she’s been a midwife, but until recently she found ways to work around it. Her fellow midwives at Countryside Midwives in Palmerston (65 km northwest of Waterloo) knew that they shouldn’t call to her from another room and they got used to being asked to repeat themselves numerous times.

Since she started wearing hearing aids at the beginning of 2016, Colgate has thought a lot about the role that hearing and listening skills play in midwifery practice.

“All of those little things that we listen to in a day are clinically really important,” says Colgate. “Listening to a woman in transition or listening to those noises when she’s first going to start to push. Or listening to a baby’s cry and wondering ‘Does that sound normal? Is it too high pitched?’ Can we hear them rattling away with mucus from across the room?”

Listening skills are also critical during conversations with clients, who may be describing symptoms of postpartum depression or disclosing other personal information.

Colgate’s hearing aids are so small that most of her clients don’t even notice them. In contrast, helping her Mennonite and Amish clients feel comfortable with a new electronic stethoscope that amplifies sound has been a challenge that Colgate didn’t predict. While no client has asked her not to use the stethoscope, Colgate says it has prompted many questions and one family asks her to explain the device each time she visits.

Using the electronic stethoscope, which can record sounds via an application on her phone, has opened up opportunities that Colgate hadn’t envisioned. If she is worried about a sound she hears through her stethoscope and can’t decide whether she should have the family make the two-hour trip to the nearest hospital with a large pediatrics department, Colgate can email the sound file to a pediatrician at the hospital and do a consult.

She also plans to help students hone their listening skills by adding recordings of common midwifery sounds to the student section of the Countryside Midwives’ website.

“If they’re having trouble with lung sounds, for example, they can hear them at a more amplified level and count them. It’s those really quiet sounds that a lot of students struggle with at first,” says Colgate.

The Association of Ontario Midwives (AOM) filed an application with the Human Rights Tribunal of Ontario against the provincial government on behalf of close to 800 midwives, alleging that midwives have experienced a gender penalty in their pay set by the government for almost two decades.

In June 2016, legal counsel from both sides made opening remarks and between September and January, hearing dates are set where witnesses from the AOM, the Ministry, as well as expert witnesses, will be examined. In a series of blogs, the AOM will keep members and the public informed about the proceedings at the Tribunal.

When AOM President Elizabeth Brandeis joined the midwifery profession in 2003, midwives’ specialized skills were increasing, along with their non-clinical responsibilities. In 2007, midwives were authorized to obtain certification allowing them to act in the role of surgical first assist at caesarean sections. When midwives are able to assist at C-sections, it helps keep birth services in small, rural communities; however, most midwives are not paid for providing this service. More data and reporting requirements and accountabilities have also added to midwives’ workloads, but they were not compensated for this work, either.

In the two decades since midwifery became regulated, there has been a significant increase in the complexity, diversity and vulnerability of midwifery clients. For Brandeis and other midwives, ensuring that clients have the support they need may involve advocating for housing and food security, accessing mental health services or helping survivors of domestic abuse develop safe exit strategies. This work is challenging and the stakes are high.

In 2012, as the AOM’s Vice President, Brandeis became actively involved in government relations and funding negotiations with the Ministry of Health and Long-Term Care. While the Ministry praised the work of midwives and the role they play in the health-care system, the Ministry insisted that it didn’t have the money to increase midwives’ compensation. When asked about compensation and pay equity, the Ministry pointed to money it had invested in growing the Midwifery Education Program and piloting birth centres, but refused to address the issue of pay equity. Interestingly, the government did find the funding to give wage increases to male-dominated engineers at Ontario Power Generation, the Ontario Provincial Police and corrections workers.

Despite a clear recommendation from the Courtyard Report (a review of midwifery compensation funded by the Ministry which recommended an immediate one-time equity adjustment of 20%), the Ministry refused to close the gender wage gap for midwives.

Brandeis and midwives across the province were dismayed by the Ministry’s complete neglect of the gender-based wage gap in midwifery work and turned to the Human Rights Tribunal to seek a remedy for this infringement on their human rights.

You can read Brandeis’ affidavit here.

The Association of Ontario Midwives (AOM) filed an application with the Human Rights Tribunal of Ontario against the provincial government on behalf of close to 800 midwives, alleging that midwives have experienced a gender penalty in their pay set by the government for almost two decades.

In June 2016, legal counsel from both sides made opening remarks and between September and January, hearing dates are set where witnesses from the AOM, the Ministry, as well as expert witnesses, will be examined. In a series of blogs, the AOM will keep members and the public informed about the proceedings at the Tribunal.

Midwife Katrina Kilroy (who was Vice President of the AOM from 2005 to 2007, President Elect from 2007 to 2008 and President from 2008 to 2012), has spent the majority of the past 25 years being on call 24/7 for her clients. Kilroy’s clients are able to page her at any time of day or night. They may be contacting her to say they’re in labour, to report bleeding early in pregnancy, or to get advice about breastfeeding or a myriad of other topics or concerns. While some issues can be resolved during a brief phone call, if a client is in active labour, Kilroy may need to jump in her car immediately to meet the client at her home or the hospital.

In her affidavit for the Human Rights Tribunal of Ontario, Kilroy says the on-call nature of midwifery work means that midwives “like many female-dominated caregiving professions, put the needs of others ahead of (their) own needs.” Being on call makes it difficult for midwives to attend to their own child care, elder care or other family or personal needs. Responding to an urgent page from a client may mean that a midwife has to miss a concert at her child’s school, leave Christmas dinner early or skip her own health-care appointment.

While Kilroy has accepted the demands and sacrifices that are part and parcel of being a midwife, she doesn’t believe that the Ministry of Health and Long-Term Care (MOHLTC) understands, values or equitably compensates midwives for the work they do.

Kilroy’s affidavit says that when she was Vice President of the AOM, it was clear to her “that the MOHLTC valued the excellent outcomes of midwifery but wanted to continue to rely on midwives as relatively “cheap labour” to produce those outcomes.”

During meetings she attended as AOM Vice President and President, Kilroy heard repeated claims from the MOHLTC that they couldn’t afford to pay midwives more; or that the Ministry would deal with the issue of midwives’ compensation after they finished negotiating with doctors or after an upcoming election or Ministry reorganization or some growth or change in the midwifery program.

“It appeared to me that the gender of our profession and the nature of our intensive work for women and commitment to them was leading the MOHLTC to take us for granted and not be concerned about prioritizing our compensation,” says Kilroy.

Ontario women want and need the continuous care that the Ontario model of midwifery offers - and midwives are passionate about providing this care. Women who choose midwives become partners in their care and midwives empower them to make informed choices every step of the way. It’s very disheartening that 22 years after the regulation of midwifery, the government still doesn’t value the work midwives do or recognize the physical, emotional and intellectual demands of the profession by compensating midwives equitably.

Read more from Katrina Kilroy's affidavit here.

The Association of Ontario Midwives (AOM) filed an application with the Human Rights Tribunal of Ontario against the provincial government on behalf of close to 800 midwives, alleging that midwives have experienced a gender penalty in their pay set by the government for almost two decades.

In June 2016, legal counsel from both sides made opening remarks and between September and January, hearing dates are set where witnesses from the AOM, the ministry, as well as expert witnesses will be examined. In a series of blogs, the AOM will keep members and the public informed about the proceedings at the Tribunal.

In her witness testimony presented to the Human Rights Tribunal of Ontario, AOM Past-President Elana Johnson (who served from 1988-89 and 2004-08) recalls many interactions in which Ministry of Health officials praise the value that midwifery brings to the health-care system, but did nothing to ensure the valuing of the midwifery work was free from gender bias.

One such example, Johnson recalls, stems from a ministry-led evaluation of the midwifery program. The positive evaluation results illustrated that midwives were contributing to the ministry’s health-care objectives and validated midwifery care’s excellent client outcomes. The evaluation did not, however, address the issue of equitable midwifery compensation.

Another example relates to Ontario’s obstetrical care provider shortage in the mid-2000s. During that time, the ministry was negotiating a contract with midwives, and midwives were continuously asking for the issue of equitable compensation to be addressed. The ministry, however, decided to expand the Ontario midwifery program to allow more students to enter the Midwifery Education Program to deal with the shortage, instead of addressing compensation issues. 

“The (ministry’s Ontario Midwifery Program) benefited from highly effective outcomes of midwives contributing to the avoiding of an obstetrical care provider shortage. By denying us equity in compensation the OMP was able to focus on expanding this “affordable” solution” Johnson states.

Read more from Elana Johnson's affidavit here.

The Association of Ontario Midwives (AOM) filed an application with the Human Rights Tribunal of Ontario against the provincial government on behalf of close to 800 midwives, alleging that midwives have experienced a gender penalty in their pay set by the government for almost two decades.

In June 2016, legal counsel from both sides made opening remarks and between September and December, hearing dates are set where affidavits from the AOM, the Ministry and expert witnesses will be examined. After each witness’s testimony, we’ll bring you a blog to help shine a light on evidence being presented and the scope of our case.

In the 22 years that midwifery has been regulated in Ontario, midwives have taken the lead in establishing the infrastructure of the self-regulated profession they developed and integrated into the health-care system. So, in addition to caring for clients 24/7 and being responsible for the day-to-day management of midwifery practice groups, midwives established their own education program, self-regulating college and professional association. However, at the same time, government failed to ensure that midwives were equitably paid for their work.

Midwives during this period – often while grappling with stereotypes, prejudice, and disadvantages due to being a group of women – also asked government to compensate them fairly for their work.

Mississauga midwife Remi Ejiwumni is very familiar with the obstacles that the midwifery profession has encountered over the past two decades. Ejiwumni provided evidence to the Human Rights Tribunal that during her term as AOM President (2001-20014) she requested that government provide increased compensation to midwives (who, by 2001, had had no change in compensation for seven years). However, government denied these requests, including a request for a basic cost-of-living adjustment.

Government also refused to fund a Hay report to look at midwifery compensation but chose to fund and implement a Hay report dealing with recommendations for CHC physicians. Under Ejiwumni’s leadership, the AOM contracted with Hay and self-funded a report. The June 2003 the Hay report provided a number of recommendations that could have led to the government establishing fair and equitable compensation levels for midwives. Despite requests to government, none of the recommendations were implemented.

Ejiwumni provided testimony to show that during her time as AOM president midwives were denied both the processes and action that could have led to fair and equitable compensation.

Lack of government action on pay equity is one of the challenges midwives have faced, and continue to face, as a female-dominated profession, providing care to women, and working in women’s health care.

Read more from Remi Ejiwunmi's full affidavit here.