(as of February 2009)
There is an astonishing amount of work involved in introducing and integrating anew health profession into an existing health system. The Midwifery Implementation Initiative is the catch-all name given to the evolving series of committees and activities that have been involved in the process since the Midwifery Act was passed in November of 2006.
The Midwifery Regulations Committee drafted the regulations and by-laws that, after complex legal approvals and final approval by the Registry of Regulations, have gone to and been approved by the Midwifery Regulatory Council.
The two committees presently overseeing the Midwifery Implementation Initiative are the Integration Committee, which is working with the three model sites and addressing the many issues that have arisen as the process moves forward, and the Advisory Team, which (as its name implies) offers advice and support to the Implementation Initiative.
The plan was that the Act would be proclaimed at the end of March, with the effective date occurring at the same time. However, there has been some talk about moving this up to the middle of March.
The Integration Committee decided to implement midwifery “incrementally”—that is bit by bit over time—mostly because there were relatively few midwives to draw from. In the Spring 2008, the Department of Health issued a call to the District Health Authorities (DHAs) asking for expressions of interest in being one of three early adopters. These model sites would get support and assistance as they worked through the process of introducing a new health profession and their experience would be documented in a manual that the remaining DHAs could follow as they, in turn, implemented midwifery. Three sites volunteered: the IWK in HRM; South Shore DHA; and GASHA (Guysborough, Antigonish, Strait Health Authority).
These sites are in various stages of readiness to implement midwifery by the projected date of March 31, 2009. All have Steering Committees working on the myriad details involved. (All of the Steering Committees have consumer representatives among their members.) Two have posted the midwifery jobs and will interview soon. All sites have faced various challenges and difficulties during the process, but it’s looking like the IWK and South Shore could be ready for midwives to practice by April 1 or soon after. GASHA will take a bit longer—they are hiring a midwife (or two) to help them with implementation and the bulk of the work won’t be done until after they starts working in April, but since there are presently no midwives practicing in that area, there is less concern about a possible gap in services caused by their late start.
This is the body that will oversee midwifery in Nova Scotia. It will develop the policies and procedures that will govern midwifery practice. The members have been appointed—there are three midwives, three public representatives, and a representative from each of the College of Physicians and Surgeons and the College of Registered Nurses. The Registrar has been hired, the MRC has held its initial meetings, and they have passed the regulations, which now need Cabinet approval. The MRC can’t do anything official until after the Midwifery Act has been proclaimed, but they can do most of the policy development and groundwork needed to enable them to begin registering midwives as soon as the Act is passed.
The good news is that very soon, midwifery will be a legal, regulated profession in Nova Scotia. Midwifery services will be covered by MSI. This is a hard-won victory for women and midwives in Nova Scotia
This doesn’t mean that we can rest on our laurels, though. There’s still a long (and probably rocky if past experience is any guide) road ahead of us before midwifery services are available to any woman who wants them, anywhere in the province and midwives can work to their full scope of practice in all DHAs.
The plan seems to have been to proclaim the act at the end of March with a simultaneous effective date. Once the act is proclaimed, it will be illegal for an unregistered midwife to practice in Nova Scotia. Lately we’ve been hearing rumors that this date might be moved up to mid-March.
I think this would be a problem because it could cause a gap in service to women currently being cared for by midwives—particularly those planning a home birth—if the midwifery services at the model sites aren’t up and running and if the MRC isn’t ready to register midwives. The end of March is cutting it pretty close as it is.
This is a longer-term concern. Once the three Model Sites—in Capital, South Shore GASHA Health Districts—are ready, midwifery services will be available to a limited number of women in those Districts. (I say, “limited” because there is initial funding for only 7 full-time equivalent midwives.) But what about the women in the remaining DHAs? As far as I can see there is not yet any kind of plan or timeline for rolling out midwifery across the province. This is complicated because each DHA sets its own priorities, and unless each one commits to introducing midwifery, it could take an awfully long time for midwives to be working in all DHAs.
Jan Catano February 2009
The Department of Health has established its own webpage about the Midwifery Implementation Initiative