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Nurses can (and must) advocate for equitable access to sustainable Canadian midwifery services

Globally, nurses, midwives and nurse-midwives, provide the majority of perinatal health care (pregnancy, during and after birth) and represent the largest professional bodies in the global health workforce. Yet in Canada while nurses have a role at most births, only 11% of births are attended by midwives. Despite the lower rate of attendance, requests for Canadian midwives and midwifery services are much greater than the capacity to meet those demands. 

This reality rests uncomfortably alongside the fact that throughout the country, midwifery services continue to be undervalued and underfunded within health care systems. In many areas expansions of midwifery services have stalled, and the sustainability of those services has been threatened. For example, midwifery services in Nova Scotia have not expanded beyond the three model sites that were established when midwifery was regulated there twelve years ago.

During the Covid-19 pandemic midwives have encountered additional stressesexacerbating a profession which already faces pre-existing sustainability challenges. Midwives have experienced challenges accessing Personal Protective Equipment, and some midwifery practices have even closed due to burnout, lack of paid sick days, and shortages of midwives. Yet, the evidence is clear that midwifery-led continuity models of care are excellent options for uncomplicated pregnancies and births and that midwifery services should be made available to all birthing people.

How can nurses support the sustainability of midwifery?

Nurses can (and must) advocate for equitable and sustainable access to midwifery services. We can support the integration of midwives into new practice settings. In existing practice settings, we can seek opportunities to work and learn with midwives, to enhance our understandings of midwifery services and the profession. Nurses are uniquely positioned to challenge structures that reinforce siloed approaches to birthing care and to help share information about the benefits of midwifery with birthing people, families, and other health care providers.

Where are nurses supporting sustainable midwifery?

Many nurses have shared their interest in creating and working within collaborative models of care where midwives are primary health care providers. Nova Scotia offers great examples of what collaboration between nurses and midwives can look like. There, registered nurses have opportunities to work with midwives at home and hospital births at the three model midwifery sites. In Nova Scotia, nurses and midwives continue to work hard to build and sustain their professional relationships. Together, all parties partner to support opportunities to work, learn, and play with each other.

Visions of collaboration

The 2021 theme for International Nurses Day is A Vision for the Future of Healthcare. This theme encourages nurses to reflect on health care currently, and to imagine what healthcare can be in the future. This is an opportunity for nurses to explore how we can lead and support changes to improve birthing care, for all families in Canada. Nurses can provide important advocacy for well-integrated and sustainable midwifery services, which are essential for collaborative, person-centred, accessible and equitable birthing care for all birthing people and their families in Canada. Together we can work with midwives to make this vision for the future of birthing care a reality.

Dr. Danielle Macdonald, PhD, RN, is an Assistant Professor at the Queen’s University School of Nursing. Danielle’s research is focused on understanding global birthing experiences, specifically as they relate to midwives, nurses, and birthing people. Find her on Twitter @dmacdonaldrn

This article has been published as part of our Nursing Week 2021 campaign, which seeks to celebrate and amplify the voices and opinions of our nursing faculty, students, alumni and colleagues. Please note that this is an op-ed style piece, and all content shared belongs to the authors.