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McMaster’s graduate midwifery program aims to give the profession a boost

‘Midwives have a lot to offer,’ says the program’s director, ‘and they’re underutilized in Canada compared to in other countries.’

BY WENDY GLAUSER | MAY 16 2022

McMaster University is launching Canada’s first master of science in midwifery program, aiming to help expand the profession’s role in health care. The first cohort will start in August 2022.

“In Canada, we don’t have very many midwives involved in leadership roles in hospitals or in ministries of health or other kinds of health-care organizations,” said Liz Darling, director of the midwifery education program at McMaster. “We think that this program will build capacity within the profession to push things forward… to create solutions and demonstrate the value that midwives can bring to the health-care system.”

In its first year, the program will enrol about 30 trained midwives with at least two years of clinical experience, Dr. Darling said. There is also a separate, facilitated admissions stream to reduce barriers faced by applicants who self-identify as Indigenous or Black. “We know that promoting equity, diversity and inclusion in leadership strengthens our ability to address societal challenges and meet the needs of the population,” Dr. Darling said.

The core curriculum of the two-year program will focus on leadership, social justice and research skills, she said. To allow midwives to continue their professional roles, the master’s degree can be completed full-time or part-time and coursework is primarily offered online, with one mandatory week-long in-person residency per year. On top of the core coursework, students can study advanced clinical skills in an area of their choice, such as contraception, abortion care, point-of-care ultrasound or surgical assistance.

Midwife-driven models of care have been growing in Ontario in recent years. In 2017, the provincial government announced funding for midwife-led health-care programs. Midwives are now running such programs at community health centres and as part of family health teams, co-ordinating postpartum care, for example, or leading programs that address the social and psychological needs of pregnant people in the community. Midwives are also leading birthing units within hospitals. The first such unit in Canada opened in 2018 at Markham Stouffville Hospital, while a second is planned at McMaster University Medical Centre. Another funding stream announced by the province in 2017 supports innovative birth centres and training programs that honour traditional birthing practices in Indigenous communities.

But Dr. Darling said such programs are the exception. That’s in contrast to other countries where midwives are more widespread in leadership and clinical roles. For example, in Sweden, midwives provide contraception, cervical cancer screening and abortion care in addition to prenatal, birth and postpartum care.

‘There are a lot of gaps’

Rebecca Hautala, an incoming master’s student, has been working in an expanded midwifery model at a community health centre in Thunder Bay, Ont. She’s doing outreach in the urban centre and surrounding communities, working with community organizations and walk-in clinics to bring people into midwifery care earlier and follow them for longer. (While midwives typically follow patients up to six weeks post-birth, her team follows them for up to six months.)

Ms. Hautala plans to use the master’s program to research the gaps in access to reproductive care in Thunder Bay, including pregnancy, birth and postpartum care as well as contraceptive and abortion care. “We know anecdotally there are a lot of gaps. We see patterns of young pregnant patients with substance use, without primary care, with housing insecurity… showing up at labour rooms without having had any prenatal care,” she said. “But these gaps are not well studied.”

Ms. Hautala is “really hopeful that [the graduate program] will help us broaden the scope of midwife” care in positive ways, both for patients and midwives. She said that the model in which midwives work on-call several nights a week in case of births “doesn’t work for all life stages in someone’s professional life.”

Jasmin Tecson, president of the Association of Ontario Midwives and a midwife with Seventh Generation Midwives Toronto, is excited for the homegrown graduate opportunity the program presents. She noted that midwives in the province have been limited to travelling internationally for master’s programs or to pursue graduate degrees in adjacent fields like health policy, public health or social work. “Midwives are always seeking opportunities to grow and expand their skills,” she said.

Pushing to be leaders

They are also well positioned to lead clinical care, research and policy changes because of their unique position working in people’s homes, in community clinics and hospitals, Ms. Tecson said. “People are able to page us 24/7. We’re able to go into people’s homes, bring the clinic to them, identify gaps and loop in other services like lactation support, social work, psychological supports,” she said. “It would be great to be able to share our learnings with the health system more broadly.”

Dr. Darling said “the hope is that the program will be approved by the Ministry of Colleges and Universities,” which will make students eligible for grants and loans through the Ontario Student Assistance Program. While the province has frozen university funding for graduate programs, and the program is being fully funded with tuition revenues, ministry approval would leave the door open for provincial funding in the future.

It’s launching a year after Laurentian University, facing a financial crisis, axed one of only three undergraduate midwifery programs in the province. The remaining midwifery undergraduate programs at McMaster and Toronto Metropolitan University (formerly Ryerson University) absorbed the students who had been training at Laurentian. “We’re hoping that there will be an expansion of the consortium again so that we’re better able to serve the needs of Northern, Indigenous and francophone students,” Dr. Darling said. “But that’s something that will take time.”

As is the historical tradition, the push for an expanded role for the profession is coming from midwives themselves. “The university didn’t create this [graduate] program because we had a bunch of hospitals coming to us and saying, ‘We want midwives to be leaders,’” Dr. Darling said. “It was coming from within the profession, that we can be leaders… midwives have a lot to offer, and they’re underutilized in Canada compared to in other countries.”

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