Horse’s Mouth: Tonia Occhionero

An Interview with Valerie Mathis

The Canadian Association of Midwives (CAM) is the national organization representing midwives and the profession of midwifery in Canada. It has spent years advocating the practice throughout the country and abroad as an essential and universal aspect of health care. The Association’s main goal is to ensure that every woman in Canada will have access to a midwife’s care. Similar efforts are being undertaken by the National Aboriginal Council of Midwives (NAMC), with whom the CAM operates in conjunction. The Daily had the chance to talk with Tonia Occhionero, CAM’s executive director, about the status, implications and advancements of midwifery in Canada.

MD: Can you tell us about the current status of midwifery in Canada?

TO: Midwifery is a very young profession. The first province to regulate midwifery was Ontario in 1994. Of course, midwifery has existed since the beginning of time, but in the sense of [a] legislated, recognized profession in Canada, it’s quite young. And just to give you an idea, in 2005, when I started with the association, we were 500 members, and today we’re a 1,000 members, so it’s already doubled in just over 5 years. There are now six four-year-baccalaureate programs across the country right now. But because it’s still young, it’s still a profession that is not necessarily known, or at least it’s not in the general knowledge of Canadians. They might not know what a midwife does, and that she’s a primary health care provider (which means that a woman would not have both a doctor and midwife, it’s either one or the other), that services of the midwife fall under healthcare, that’s it’s a publicly funded service. So part of our mission is to advocate for the profession.

MD: How do you advocate midwifery across the country?

TO: Because we regroup the different associations across Canada, we do a lot more work for the midwives themselves and for the profession. We advocate mostly to governments, public health agencies, and we generally work with them to bring midwifery forward to their public agenda. We organize a yearly annual conference, and that travels from one province to another, so we try to travel across the country to give exposure to the provincial situation. Because health care is provincial, it’s a bit difficult to have a national organization to bring forward the issues because they can be very different from province to province. For example, if you go to Prince Edward Island, it’s not even legislated or regulated yet, so what we would do to help midwifery [there] would be very different from what we would do in Ontario, where there are currently 500 regulated midwives who have practices and it’s multiplying every year and very well established.

Also, May 5th is the international day of the midwife, in which we try to gather all midwives across the country to work on similar initiatives. This year, there are going to be marches planned in communities across the country from coast to coast to raise awareness on maternal and newborn health around the world. So it would be more of an international field to the marches and the message that we’ll be bringing forward on that day.

MD: Can you tell us about the overall benefits of midwifery in pregnancies?

TO: It’s been demonstrated in many different studies how it’s extremely cost-effective and the outcomes are better, and it leads to less complications. Also, the quality of health care is absolutely increased for midwifery, and for many reasons: the much lower number of interventions and complications, the cost-effectiveness of midwifery as opposed to hospital births, and also the quality of service. There’s actually a national study out on satisfaction rate with the health care provider for women who have given birth which was published not too long ago. Midwifery clients came out with a very high satisfaction rate. So, not only the financial aspect and impact on the health system, but the service satisfaction was very high.

MD: How does the association deal with the implementation of cultural norms in midwifery practices, as seen in the goals of the National Aboriginal Council of Midwives?

TO: We’re the professionals’ association, looking out for the profession of midwives, and then there’s the regulators’ consortium, and they regroup all the colleges of the different provinces, look out for public safety, and really regulate – how a midwife gets registered, [the criteria she has to meet]. [Any] programs, be it any educational program including the programs for [bridging together] internationally-trained midwives, would fall under them.

Now, aboriginal [contexts are] maybe different: there are aboriginal midwives in Canada who are registered through their province, who follow a recognized education program, and there are also traditional aboriginal midwives [in] communities in Canada that have come up with their own training programs within their communities that have been recognized by their provinces. So it’s a bit more complex. For example, if you look up Nunavik in Northern Quebec, and there’s also a section in Ontario, those are communities that have been able to really bring birth back to their communities and also have a training program that identifies and teaches the core competences and skills that a midwife needs within that particular cultural, traditional context.