By submitting his voluminous reform project last spring, the Minister of Health, Christian Dubé, wanted to “make the health system more efficient”. To do this, the minister focused, among other things, on better collaboration between the different professionals within the network and a reduction in the weight of doctors in decision-making processes. Noble intentions, some will say…
Medical subordination
Last week, while the detailed study of Bill 15 continued in the National Assembly, the minister’s real objectives became clearer: place midwives under the hierarchy of a medical director and submit their work to the evaluation of a professional council made up of a large majority of doctors where they will always be in the minority. Midwives will lose the professional autonomy for which they have fought for almost half a century.
Because, it must be remembered, midwives view childbirth as a normal biological process which belongs to the pregnant person, carrying profound meaning for the woman and her family.
At the moment, Bill 15 is nothing more or less putting midwifery practice under medical supervision, and this without the main stakeholders — midwives and users — could not be consulted. What is being decided is essentially the end of the midwifery profession as it has been claimed to date.
An attack on fundamental rights
The year 2024 will mark the 25th anniversary of the legalization of midwifery in Quebec and its integration into the health network. This legalization was the fruit of so many years of struggle for the recognition of this essential profession which relies on women’s freedom of decision.
For a long time, women have asked to be able to choose their place of birth, to choose the type of care they wish to receive throughout their pregnancy, during childbirth and in the weeks following it.
If midwifery practice and the birth centers where it is offered have been able to develop despite the prejudices that midwives still face, it is precisely thanks to their professional autonomy, protected by structures and mechanisms provided for in the Current Health Services and Social Services Act.
Nearly 25 years later, the minister is threatening to undermine the very foundations on which the profession was built and deployed.
With this bill, women and pregnant people have the right to wonder if, at the end of the day, they will still be able to have their fundamental right to choose by and for themselves what they consider most desirable and respectful of their pregnancy, their childbirth and their baby.
Will being able to choose still be possible?
Many clinical situations that are currently addressed in depth and discussed by the family and midwife will be subject to limitations. Chatting takes time. Appointments lasting 45 minutes to an hour are one of the most appreciated and important elements of follow-ups with a midwife.
Placing midwives under the supervision of other professionals who practice in a different and distinct paradigm of care will encourage the growth of a pathological approach to pregnancy and childbirth. Experiencing a vaginal birth after cesarean section (VBAC) in a birth center or at home; decide on pregnancy diabetes screenings or ultrasounds, it is possible with midwife monitoring. All choices that are threatened.
With the development of rules which will have to be approved by the medical profession as well as the lack of midwives available to support families in this major event, we ask ourselves: being able to choose to give birth at home, is that will it still be possible after the adoption of Bill 15?
Evidence from scholarly studies as well as recommendations from international health authorities, such as the WHO, confirm the positive impacts of autonomous midwifery practice, focused on supporting the physiology of the perinatal journey.
It’s time to mobilize
We, the signatories of this letter, are today launching a call for a vast citizen mobilization to prevent the placing of midwifery practice under medical supervision in Quebec. “Neither pope, nor judge, nor doctor, nor spouse, it is up to women to decide!” »: this is a slogan that is still relevant today.
Mr Minister, let us be clear: we will not let this happen!
*Also signed this letter:
Marie-Eve Blanchard, General Director, Respected Births Group (RNR); Roxanne Lorrain, Co-coordinator, Movement for Autonomy in Childhood (MAE); Valérie Allard, President of the Association of Student Midwives of Quebec (AESFQ); Françoise David, Ex-president of the Federation of Quebec Women; Laure Waridel, mother of two children born with a midwife; Thomas Bastien, Director of the Association for Public Health of Quebec (ASPQ); Danny Roy, President of the Federation of Professionals (FP-CSN); Laurence Guénette, Coordinator, League of Rights and Freedoms (LDL); Marceline Fandjo, Group of 13, composed of the following members (Women’s Health Action, Quebec Breast Cancer Action, Women’s Work Action, Feminist Education and Social Action Association, Alliance of 2nd stage shelters for women and children victims of domestic violence, Documentation Center on adult education and the status of women, Intervention Council for women’s access to work, DAWN-RAFH Canada, Federation of single-parent and reconstituted family associations of Quebec, Federation of Quebec Women, Federation of women’s shelters, Quebec Federation for birth planning, Indigenous Women of Quebec, L’R of women’s centers of Quebec, Movement for autonomy in childbirth, Regroupment homes for women victims of domestic violence, Regroupement Naissance-Respectées, Quebec grouping of centers for assistance and the fight against sexual assault, Relais-femmes, Action network for the equality of immigrant and racialized women in Quebec , Quebec Lesbian Network — Women of Sexual Diversity, Network of Regional Tables of Women’s Groups of Quebec, Consultation Table of Organizations Serving Refugees and Immigrants); Marie Simard, Director General of the Confederation of Family Organizations of Quebec (COFAQ); Arnold Aberman, Let’s Take Care of Social Justice Collective; Tristan Ouimet Savard, Responsible for mobilization and popular education of the Quebec Network of Autonomous Community Action (RQ-ACA); Geneviève Lamarche, Coordinator of the Health Solidarity Coalition; Adina Ungureanu, Coordinator of the Alliance of Cultural Communities for Equality in Health and Social Services (ACCÉSSS); Mona Greenbaum, Executive Director, LGBT+ Families Coalition; Nadja Pollaert, Director General, Médecins du Monde; Marielle M’bangha, Coordinator of the Reference Service for Immigrant Women of Quebec (SRPFIQ); Raymond Villeneuve, Director General, Grouping for the Valorization of Fatherhood; Christine Marcotte, General Director, Allaitement Québec; Sylvie Pedneault, SOS Pregnancy; Sandrine Jeanjean, La Leche League; Sylvain Lafrenière, Coordinator of the Grouping of collective organizations in collective defense of rights (RODCD); Martin Trudel, 3rd vice-president of the Union of Professionals of Quebec (SPGQ); Françoise Ramel, Vice-President, Interprofessional Health Federation of Quebec (FIQ); Kim Couture, Director of MAM around maternity and spokesperson for the Montérégie birth center movement; Julie Rousseau, Director, À la Source Sept-Îles; Julie Ringuette, Actress, presenter, mother of 2 children born with a midwife; Véronique Martineau, Coordinator, Montreal Women’s Group Table; Catherine Gauthier, coordinator, Regroupement des groups de femmes de la Capitale-Nationale region; Anne-Marie Aumond, General Director of Nourri-Source Estrie; Sylvie Gauthier, Director, Naissance-Renaissance Outaouais; Janie Vachon-Robillard, Director of the Porter la vie School; Marie-Ève Tousignant, Administrative Coordinator at Alternative Naissance; Isabelle Challut, Co-founder of the Pleine Lune Center; Marie-Hélène St-Pierre, Perinatal Advisor at Ressources Naissances; Guillaume Lajoie, President at Mieux-Naître in Laval; Élise Côté De L’isle, Founder Fondation Coeur de Mère; Annick Bourbonnais, Director and birth attendant, Perinatal Academy; Sonia Gagnon, Coordinator, Nourri-Source Lanaudière; Line Verville, General Director, Victoriaville Family House
The full list of signatories is here.