Midwifery became a regulated health profession in the Canadian province of Ontario in 1994, making Ontario the first province in country to regulate midwifery. As provision of health care is the responsibility of individual provinces and territories in Canada, some provinces and territories have yet to regulate the profession. In Ontario, midwives' scope of practice includes providing primary care to low-risk pregnant women throughout pregnancy and labour and for up to six weeks postpartum. Research on Canadian midwifery care suggests that women who receive midwifery care have increased satisfaction and fewer interventions: including lower rates of induction, cesarean and instrumental deliveries. Midwifery services are publicly funded through the Ministry of Health and Long-Term Care (MoHLTC) and Ontario has the largest midwifery workforce in the country with just over 700 practicing midwives.
Midwifery in Ontario has grown and evolved since regulation, with 13.5% (19,191) of births attended by midwives in 2013-2014. This growth is reflected by increasing demand for midwifery services, such that 40% of women seeking this type of care are unable to access it due to demand exceeding current supply. The Ontario midwifery model of care focuses on community-based practices where prenatal care is provided in the community and clients have a choice of birth setting, while early postpartum care is provided in the client’s home. Until recently, choice of birth setting with midwives was either at home or in hospital. However, as of 2014 birth centres are being offered as a third option. The MoHLTC has launched two midwifery-led birth centres located in Ottawa (Ottawa Birth and Wellness Centre) and Toronto (Toronto Birth Centre), as part of the Liberal government’s Action Plan for Health Care, which heavily supports community-based care.
In providing this third option, the MoHLTC’s goal is to provide women with an alternative birth environment, attended to by midwives. These facilities provide services for a total of 900 births per year, yielding a small increase the availability of hospital beds for high-risk births. As birth centres are new and a program evaluation is needed, markers of success will include client satisfaction, clinical outcomes, utilization patterns/demand and reduced health care costs when compared to hospital settings. Due to the novelty of the reform, it is too early to determine whether the goals of the reform have been achieved, however, the 2014 Ontario budget discusses the ten-year plan for the economy and cites birth centres as an opportunity to build capacity in the community.