Midwives have been practicing in Canada for as long as women have been giving birth. Historically, the delivery and payment of these services was private and unregulated. However, following the death of an infant under the care of an unlicensed midwife in the mid-1980s, Canadian provincial governments began to legislate the profession.
Research literature has shown midwifery to be a safe, cost-effective option for pre-, intra- and post-natal care. Indeed, many studies have found a variety of child and mother outcomes (e.g., episiotomy, instrumental birth, pre-term births, fetal loss before 24 weeks gestation, and breastfeeding success) to be more favourable with midwifery than under the oversight of other medical professionals.
In the province of Nova Scotia, successive provincial administrations commissioned feasibility studies for midwifery throughout the late 1990s and early 2000s. In addition, government-sponsored working groups recommended the implementation of licensed midwifery as part of public medicare several times. Frequent changes in government prevented the programme from being established for many years. Finally, in 2006, the provincial government regulated and committed ongoing funding for midwifery services, becoming the seventh subnational jurisdiction in Canada to do so. Funding was dispersed to three out of the ten regional health authorities (RHA) in the province, and each of these “model sites” was mandated to integrate midwifery services into existing maternal care teams and systems. Seven midwives were hired in the province.
Though a standardized evaluation process has not yet been established for the midwifery programme in Nova Scotia, ad-hoc evaluations have occurred. These have focused on evaluating the implementation of the services, the integration of midwives into the system, and client responses to the care they received from the government-funded midwives. These initial evaluations highlighted many challenges in the streamlining of midwifery services, including: the professional and philosophical differences between physicians, nurses, and midwives regarding attitudes towards childbirth; the difficulties in remunerating obstetricians who provide guidance to midwives, and the inability to provide home births in many cases because of a lack of personnel. Most conclude that the RHA programmes would require more midwives to facilitate on-call scheduling that would allow for more home births. Another shortfall of the programme was that after the legislation passed, it became very costly for licencing and insuring for non-public midwives; no private midwives continued to practice in the province, leading to an unmet demand for midwives, particularly in those areas outside of the three regions chosen as model sites (Morrison, 2014).
Despite these shortfalls, demand for midwifery services in Nova Scotia remains high. Moreover, there is considerable stakeholder commitment to work toward the long-term success of the midwifery program in Nova Scotia with continued advocacy work from interest groups.