Thank you, Mr. Speaker and Mr. Bell. The Standing Committee on Social Programs is pleased to report on Bill 24, Midwifery Profession Act.

During the past month, committee had the opportunity to consult with interested citizens and organizations in person, and have received written submissions from many more. On September 8, 2003, the committee traveled to and conducted public hearings on this bill in Fort Smith. Approximately 30 witnesses made presentations to the committee in that community. Without exception, all witnesses supported the introduction of midwifery legislation. However, concerns respecting some aspects of the bill were discussed.

On September 9th the committee conducted public hearings in Hay River. The committee conducted hearings in Wha Ti on September 11, 2003. Public Hearings in Yellowknife were conducted on September 15th and 18th of this year.

Even before this bill was referred to committee for public consultation, Members believed legislation was urgently needed to regulate the practice of midwifery in the Northwest Territories. Five provinces and territories have already established legislation, and the committee wanted to ensure that the Northwest Territories could count itself among the leaders respecting midwifery legislation in Canada.

Issues

Designated Sites Clause

There was one concern brought forward by the majority of witnesses who attended public consultations in Fort Smith, Hay River, Wha Ti and Yellowknife, and also by those who took the opportunity to make written submissions.

The legislation required that the practice of midwifery for compensation could only occur at sites to be designated by the Minister of Health and Social Services. Absent such a designation, any person practicing midwifery would be doing so contrary to the act and would be liable to prosecution.

Those who identified the issue were unanimous in their opposition to its inclusion in legislation. Many strong, varied and valid reasons were presented to committee outlining why the designated sites clause should be removed from the legislation.

An Infringement Of Equality Rights

Ms. Leslie Paulette, a midwife in Fort Smith and a member of the Midwives' Association of the NWT and Nunavut, suggested that a restriction on where midwives may practice is "contrary to the Canadian Model of Midwifery and to the Canadian Charter of Rights and Freedoms."

Ms. Leslie Leong, a recipient of midwife care in Fort Smith, also brought to committee's attention the issue of equality when she stated, "I want to know that I can go anywhere in the NWT and still have the same choice that I would normally have in another community."

The Right Of A Woman To Choose The Place Of Birth

The right of a woman to decide where her baby is born was mentioned several times throughout the proceedings. Ms. Claudette James, a recipient of midwife care stated, "if a properly licensed and trained midwife is available and there are no medical complications, then a family should be able to make the decision as to where they would like to have their baby." Ms. Nikki Paziek, a midwife care recipient and director of the Nik'e Niya Community Birthing Centre in Fort Smith, and Ms. Shannon Lefebvre, a Hay River resident who has plans to pursue a career in midwifery, echoed this sentiment.

Although the committee could foresee many of the arguments against the designated sites clause, members were also aware that one intent of the clause may have been to ensure that during the process of birth, women and their babies would have immediate access to surgical backup. Public consultation fostered a better understanding of the responsibilities of midwifery. Members of the standing committee were advised that registered midwives are adequately trained to assess the degree of risk to individual pregnancies. Ms. Esther Doucette, a Fort Smith woman using the services of a midwife informed us that "the designated sites clause is...redundant...because the women, as well as the midwives, will be making healthy choices around birthing." If a woman is at an elevated risk for complications, a midwife will be directed by practice standards to refer the client to a physician. "Midwifery care is for pregnancy that is not at risk," the committee was told by Ms. Nadia Laquerre, vice-president of the Nik'e Niya Community Birthing Centre.

Better Outcomes Close To Home

In a written submission by the College of Midwives of British Columbia, the committee was made aware that "current evidence indicates that better outcomes are achieved when maternity services are offered in the communities where women live, even if those services are sometimes limited in scope." The committee was provided with a document entitled Report on the Findings of a Consensus Conference on Obstetrical Services in Rural or Remote Communities that detailed the benefits of birth within a woman's home community. The National Aboriginal Health Organization, the Canadian Association of Midwives, and the Dene Nation also took the opportunity to refer the Standing Committee on Social Programs to this document.

Continuity Of Care

An important issue brought forward by Ms. Stephanie Marlow, an expectant mother in Fort Smith, and Ms. Pertice Moffatt, a registered nurse in Yellowknife, was continuity of care. Pregnant women want to be able to forge a relationship with the person who will deliver their babies. If they must travel outside of their community for scheduled checkups and birth, they will likely see several different physicians. By allowing a woman to remain within her community for the duration of her pregnancy, she has the opportunity to develop a familiar relationship with her caregiver.

Costs Of Travel

Many of those who spoke out against the designated sites clause identified travel costs, both financial and emotional, as a primary concern.

If the cost of travel is not covered by insurance, forced travel to Yellowknife or Inuvik is a significant financial burden on expectant women and their families. The standing committee was also reminded of the fact that babies are born when they are ready to be born, and do not always arrive on the estimated due date. It is common practice to send women to a larger centre two weeks prior to their delivery date. For a family to live in a hotel and eat restaurant meals for a two-week period is quite expensive, if not covered by insurance, and even more so if delivery is one or two weeks later than expected.

Also, if a woman is uprooted from her community to give birth, she lacks the emotional support she would have if she gave birth nearer to family and friends. Ms. Claudette James, Ms. Eleanor Elias, Ms. Marnie Villeneuve and Ms. Sheila Chadwick, all midwife care recipients in Fort Smith, did a fine job bringing these concerns to our attention.

In addition, Mr. Speaker, many pregnant women find it necessary to leave their other children at home in the care of a spouse or others. This often creates anxiety and hardship for the expectant mother and for those remaining at home.

Another argument against forced travel to major centres is with respect to the question of public funding of registered midwives. If this legislation is viewed through the lens of cost-saving, it makes sense to provide funding for midwives in communities in the expectation that there will be fewer costly medical evacuations and reduced travel costs for low risk deliveries. Mr. Clayton Burke, a concerned grandfather in Fort Smith, pointed out that the government "could have paid many midwives over the years for the cost of transporting these young ladies, and sometimes their escort or family, back and forth to Yellowknife." Ms. Chadwick and Ms. Gisela Becker, a midwife in Fort Smith and member of the Midwives' Association of the NWT and Nunavut, also made this point.

During clause-by-clause review of the bill, committee passed four motions which have the effect of removing the designated sites provisions from the bill. The Minister agreed to these amendments.

Public Funding

Mr. Speaker, the next most prominent issue brought forward was the issue of public funding of midwifery. Ms. Becker and Ms. Paulette, the two midwives working in Fort Smith, have been accepting what payments women and their families can give, but have, in effect, been requiring no payment for their services. Several of the women who have used their services came forward to applaud this legislation for providing a framework that will allow public funding for a service they believe to be essential.

Ms. Jennifer Potvin, one of those women, stated midwifery "must be publicly funded so that women aren't dissuaded from using midwifery services solely because of cost." Ms. Laura Aubrey, another woman receiving care from Fort Smith midwives, said public funding is essential "so that midwives can be paid and treated like professionals, which they are."

Ms. Paulette, herself, made the point that public funding is imperative if the Northwest Territories hopes to attract and maintain midwives. As she observed, "it won't be very helpful if...women have access to midwives theoretically, but there are no midwives to provide the services."