Midwives in Quebec in 2013

Why should you choose a midwife for prenatal care?

With a midwife, you get personalized and attentive care from the beginning of your pregnancy until six weeks after childbirth. The midwife is there to provide all the care you need during pregnancy, while giving you choices on how you want to live your pregnancy as revealed by Sandra Demontigny, a midwife: « I want every woman to have the choice of who will offer them prenatal care and where she will give birth. Midwives are the guardians of natural childbirth. We support women with prenatal physical and medical preparation in addition to handling the psychosocial issues faced by the family. We share our knowledge to enable the family to make informed decisions that follow their values. Our desire is to give the power of delivery back to women by guiding them and ensuring that everything happens normally. »

No matter what the advantages are, the majority of women still choose to give birth with an obstetrician or gynecologist, specialists that should be used only in the case of problems during the pregnancy as explained by Claudia Faille, president of the group of midwifes of Quebec: « 60 % of women in Quebec give birth with the assistance of an obstetrician or gynecologist while about 85 % of pregnancies are normal. We have a distorted vision of pregnancy, we see it as risky and dangerous, and that is completely false. Pregnancy is a normal physiological stage in the life of a woman. Front-line professionals, that is to say, family doctors or midwives, who have all the necessary skills to ensure proper monitoring, should always support a pregnancy that is normal. »

Practical information: Did you know that being followed by a midwife is covered by the RAMQ? You therefore have nothing to pay for receiving the services of a midwife during your pregnancy.

According to the Coalition for midwifery, in a CROP survey commissioned by the CSN and published in April 2010, 26 % of women in Quebec would like to give birth in a birthing center or at home and 11 % of women want to have a midwife handle their prenatal care. However, according to Claudia Faille, midwives do only 2.6 % of births in Quebec. What explains the difference? Not enough birthing centers, not enough midwives to meet the demand – there are currently only 160 working midwives in Quebec – and the lack of services.
The daily reality of a midwife

All the midwives we spoke to love their work and it’s easy to detect the passion they hold for everything that surrounds pregnancy, women and their families. Like Genevieve Guilbault said it best: « It’s not always easy! We have to be organized and constantly adapt. We don’t always know when our pager will sound, when our workday will end, if we’ll have an impromptu home visit or even if we’ll be able to sleep that night! But this contact with the women, couples, families, the relationships we build over time, that’s what makes it all worth it. To have the privilege to share with people the most intimate moments in their lives and to be amazed every day by the power and strength of a woman in labor, this is what we live for. ».

How does society view midwives?

Although the practice of midwives is increasingly recognized in Quebec, there is still a long way to go to change some misperceptions that persist due to lack of information as Genevieve Guilbault tells us: « The population is more informed and aware of our practices, but there is still much work to do to demystify our profession to the public and the government. The government should support our practice model by opening more services and birthing centers so every woman can have the access to a midwife if she wants one. It’s this same misunderstanding of our practice that hinders our current negotiations regarding our employment conditions and wages. The government should grasp the richness of the overall approach and provide women and midwives the opportunity to develop this wealth. ».

Since the profession of midwifery was legalized in 1999, there has only been one employment conditions and wages agreement that was signed in 2004 and that agreement expired in 2005. Since 2009, the midwives have attempted to negotiate the terms of a new agreement. So far, they have been disappointed by the response they have gotten, yet they remain hopeful that things will change in the future as explained by Claudia Faille: « The government tells us our demands are too high, but they ignore the fact that it’s been almost 10 years since our last agreement, which in itself wasn’t even that advantageous to begin with since there was limited knowledge of our profession back then. And yet, the evidence is there: we need midwives, women want to return to more physiological births and midwives are a part of the solution. ».

How to become a midwife

In Quebec, there is only one recognized program to become a midwife, a Baccalaureate program on the practices of midwifery given by the University of Quebec in Trois-Rivières and that lasts four and a half years. Midwives who complete the program successfully then have to become members of the Ordre des sages-femmes du Québec to practice their profession legally.

Relationship between midwives and medical professionals

It’s not just with the government that we still notice a lack of knowledge of the practice of midwives and the role they play in a woman’s pregnancy. Indeed, although they regularly work with medical staff, they realize that there is much work to be done to improve relationships and create a better collaboration as noted by Geneviève Guilbault: « We see some health care professionals question our annual numbers and saying our figures are very low compared to theirs. I wish they would realize that we don’t just do the work of a physician, we also assume the role of other professionals and it is this continuity in the services we offer that is our wealth and that that is what women are looking for. ».

Sandra Demontigny adds that: « The lack of fluidity and transparency in communications with certain medical professionals is difficult to manage. It’s tough to do what you are supposed to do when all these people carry erroneous prejudices against what you do and when you have to constantly break down these myths so that we can provide women with the best possible care. » When asked what should would like these medical professional and families who are considering using the services of a midwife, she told us with conviction: « Give yourself the chance to know exactly what the services you can expect to receive from a midwife and you will see that our services are high quality, safe and adapted to the needs of women and families all around the world! ».

Sources : Ordre des sages-femmes du Québec, Regroupement les sages-femmes du Québec, Université du Québec à Trois-Rivières – Baccalauréat en pratique sage-femme, Canadian Midwifery Regulators Consortium,   Canadian Association of Midwives, CSSSBNY – Pratique sage-femmeSanté et services sociaux du Québec - Politique de périnatalité 2008-2018, Métiers Québec – Pratique sage-femme.

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