Home
 
1 2 3
 
History of Midwifery in Newfoundland and Labrador

In 1892 Dr Wilfred Grenfell arrived in Newfoundland. He established hospitals in Labrador and on the Great Northern Peninsula of Newfoundland which were staffed by British nurses who were often midwives.   In 1920 midwifery legislation was passed in Newfoundland. The Government appointed a Board to examine and provide midwives with licences to practice. Lady Harris, the wife of the Governor, immediately went to Britain to recruit nurses who were midwives and health visitors (public health nurses) to come and work in Newfoundland outports. The outports were responsible for providing accommodation and paying the nurse's/midwife’s salary.

In 1924 the Newfoundland Outport Nursing and Industrial Association (NONIA) was established to assist the communities in paying the nurses/midwives by the selling of crafts. NONIA also bought the medical supplies which the nurses needed. In 1934 the reorganization of health care resulted in cottage hospitals being built, where women were expected to go for the birth of their babies. NONIA was no longer responsible for nursing in the outports as this became the responsibility of the Department of Health.

The 18 month midwifery and paediatric program which had been provided by the Salvation Army Grace Maternity Hospital in St. John's from 1924 was discontinued in 1934. Women, who were not nurses, had been able to enter this program, although once the Nursing School commenced in 1929 many midwives who graduated from this program decided to become nurses.

In 1934 the Department of Health became responsible for training midwives who were not nurses. These women who were in their 30s were brought to St. John's to attend a 2 month course at the Salvation Army Grace General Hospital. After their training they were provided with the basic essentials that could be replenished, for a birth, for both the mother and baby. For example when they had used the supply of solutions or silver nitrate they could requisition a further supply.

Most outports chose a well respected woman to be a midwife. When this midwife was getting older an apprentice was chosen by the community to assist the midwife and learn about midwifery. The midwife was often paid in kind according to what the family could afford. When midwives received an education they moved to a community to practise, which was usually not from where they originated. The educated midwives expected payment in money, and McNaughton (1989) called them entrepreneur midwives.

In 1949 Newfoundland and Labrador became a Canadian province. In 1958 the Hospital Insurance Act came into effect and women no longer had to pay $15 to be attended during childbirth; care in hospitals was now free. In 1961 and 1962 there were no applications for new licenses, and in 1963 there was only one renewal application. Therefore, the Provincial Government considered that midwives were no longer required and ceased to appoint a Board to issue annual licenses to midwives practising in the province. Bill 56 to repeal "An Act Respecting the Practice of Midwifery" was passed by the Government of Newfoundland and Labrador in December 2008.

In 1979 the first class of nurses was admitted to a midwifery program at the School of Nursing, Memorial University of Newfoundland. Midwifery was also part of the University's Outpost Nursing diploma program. The last class to graduate was in 1986 due to financial restraints that prevented it from being offered again. In 1992 the obstetrical unit at St. Clare's Mercy Hospital was combined with the obstetrical unit at the S.A. Grace General Hospital. In 2000 the S.A. Grace General Hospital was closed and the obstetrical unit moved to the Health Sciences Centre/Janeway Hospital, a tertiary care setting. This is the only hospital in the eastern part of the Avalon Peninsula where maternity services are offered. Some women make private arrangements to have a home birth attended either by an out-of-province midwife who they fly in for the occasion or a local unregulated midwife.

In 1993 the Provincial Government appointed an Advisory Committee on Midwifery and it recommended that an implementation committee should be appointed. The final report was presented in May 1994.  In the autumn of 1999 the Provincial Government appointed a multi-disciplinary Midwifery Implementation Committee with Brenda Fitzgerald (social worker), Executive Director of Health and Community Services St. John's Region, as the chairperson. After Ms. Fitzgerald transferred to another position, Karen McGrath (social worker) was appointed as chairperson. The first meeting was held on October 20, 1999.

The main task of the Midwifery Implementation Committee (MIC) was to provide advice on the development of legislation related to midwifery and the implementation of midwifery services in Newfoundland and Labrador. The Committee was also responsible for providing recommendations related to the scope and standards of midwifery practice, midwifery education and registration requirements, and eventually the establishment of a Board (College). For this purpose subcommittees were formed to study these items and what was needed to communicate to professionals and the public about midwifery in the 21st century. The Midwifery Implementation Committee completed its mandate and the final meeting was held on October 22, 2001. The government then decided to shelve the idea of midwifery legislation. A Final Report of this Committee was never made available to committee members despite their requests.

On December 8, 2008 when there was the second reading of Bill 56 to repeal the old Midwifery Act the Minister spoke at length about modern day midwifery being "an autonomous profession practicing with a set of guidelines that will define their scope of practice and define, through regulation how they will be a part of a health care team." He then said,

"I have given an undertaking in this House, as a minister, to engage my staff in our department to develop the necessary legislation and the policy framework that will allow us to come back into this House next year and we will introduce a bill. We will be introducing some ground breaking legislation for this Province as we introduce a new umbrella piece of legislation dealing with a variety of health disciplines of which will be the practice of midwifery. We look forward to working with the provincial association in consultation as we develop this particular piece of legislation."

In November 2009 a letter was received with an invitation to participate in consultations concerning the umbrella legislation.

"The Department of Health and Community Services has been researching legislative models for 'umbrella legislation' to govern a number of health professions that may require regulation. Our goal is to construct a statute that governs a number of health professions as opposed to stand-alone statutes for individual professions.”

Four members of AMNL and the coordinator of Friends of Midwifery attended a meeting at the Confederation Building for a presentation explaining the "Umbrella Legislation Discussion Paper" that listed 14 unregulated professions, although midwifery was the only listed profession not practicing in the province at that time. Responses to this discussion paper and to another questionnaire regarding "Occupations Seeking Regulatory Status" were submitted in the middle of December, 2009.

 Nothing further was heard regarding this proposed legislation until May 4, 2010 when the representatives of the various professions who attended the consultation meetings were invited to a late afternoon meeting being held the following day. At this meeting the attendees were advised that Bill 17, an Act Respecting the Regulation of Certain Health Professions was being introduced into the House of Assembly the following afternoon. In June 2010 Bill 17 had second and third readings and received assent. The professions listed in the schedule attached to the Act were required to develop regulations, determine who would compose their respective Colleges and decide on two of their members to sit on the Council.  There is one registrar for all professions on the Council. The registrar is not a member of the Council.  When one or two professions were ready to be regulated the legislation came into effect. Health Professions Act

AMNL nominated Pearl Herbert and Kay Matthews as representatives of midwives on the Council of Health Professionals. In August 2011 Pearl Herbert and Kay Matthews, each received a letter from the Minister of Health and Community Services advising that he was "pleased to affirm your appointment as a Member of the Newfoundland and Labrador Council of Health Professionals in accordance with sections 8 and 9 of the Health Professions Act. Your appointment will take effect from July 25, 2011 and will expire on July 25, 2012."  (This date has now been extended to 2014) 

The first meeting of the Council was called for September 27, 2011. The Council consists of 6 members of the public and two representatives for each of the six health professions (as two of the seven listed in the Schedule of the Act have amalgamated). The first work of the Council was to develop By-Laws for the Council, and employ a Registrar.

The Minister has said that apart from initial funding to set up the Council there is no additional funding for the work of the Council or Colleges. Currently six of the seven listed professions are regulated; midwifery, however, is yet to be regulated. The Council of Health Professionals is responsible for regulating and registering the members of the listed professions. Web Site NLCHP

Midwifery in this province does not have a niche in the health care system. The documents prepared for the MIC (1999-2001) have been updated where necessary. The main outstanding issues include; funding, especially for the initial registration process for midwives and employment in order for midwives to have liability insurance with HIROC, the provider of insurance for the majority of midwives in Canada.

It is crucial that midwifery in Newfoundland and Labrador is publicly funded, as in the other provinces/territories where it is regulated.  Also to be decided is how midwives from jurisdictions outside of Canada will initially be registered. Midwives registered in Canada are covered by AIT Labour Mobility. Midwives are midwives; they practice autonomously and do not require any further qualifications.

The annual national Canadian Association of Midwives conference was held in St. John's in October 2012. At that time the Minister of Health and Community Services said that they were "studying how best to integrate midwifery into the health care system. Regulation for all professions under our Health Professions Act is a priority for our government". Karyn Kaufman, retired Dean of the midwifery program at McMaster University, and Helen McDonald, practicing midwife and faculty member at McMaster University were contracted by the provincial government to advise on the implementation of midwifery in the province. They visited the province from May 8 to May 15, 2013 to interview stakeholders. AMNL members had a meeting with the two consultants on May 11. The government requested the report for the fall 2013. The report was received by the Minister of Health and Community Services on December 31, 2013. The report Implementing midwifery in Newfoundland and Labrador was released on February 27, 2014.

AMNL hopes that in the not too distant future midwives will be able to provide woman  centred care that meets individual needs, that promotes the healthy, normal process of pregnancy and birth, to mother and baby until 6 weeks after the birth, for all those in Newfoundland and Labrador who desire midwifery care.

Pearl Herbert

The following are examples of where more information regarding the history of midwifery in Newfoundland and Labrador may be obtained:

 

Benoit, C. (1991). "Midwives in passage". St. John's: ISER, Memorial University of Newfoundland.


McNaughton, J. (1989). "The role of the Newfoundland midwife in traditional health care 1900-1970". Unpublished doctoral dissertation. Memorial University of Newfoundland.


Nevitt, J. (1978). "White caps and black bands". St. John's, Jesperson.

"Report of the Northern Childbirth Workshop". (Held at Makkovik, Labrador, January 30 to February 1, 1990).


North West River: Labrador Inuit Health Commission. Other materials which have been researched in this province:


Beaudry, R. (1997). "Women's lived experience with midwifery support: A phenomenological study". Unpublished masters thesis. Memorial University of Newfoundland.


Corkum, D. (1998). "Breastfeeding: Attitudes, perceptions and practices in Labrador". Goose Bay: Local Public Health Information Development, Melville Hospital. (Includes the midwives located at Melville Hospital).


Okalakatiget. "Prenatal awareness" video. Available from the producer, P.O. Box 160, Nain, Labrador, A0P 1L0 (Fax: 709-922-2293)


O'Leary, S. (1998). "Motions". A celebration of lifecycles video. Available from the producer, P.O. Box 1132, St. John's, NF, A1C 5M5 (Telephone: 709-722-4662)


Plummer, K. J. (1999). "Government-sanctioned midwifery in Canada, 1919-1991". Unpublished master's thesis. Yale University School of Nursing (contains much information about Newfoundland and Labrador).


Plummer, K. J. (2000). From nursing outposts to contemporary midwifery in 20th century Canada. "Journal of Midwifery & Women's Health", 45(2), 169-175.