This is a first in the history of midwives. With the implementation of Santé Québec, this profession, recognized in the province for 25 years, will be subject to the decisions of doctors. This new governance worries some midwives, who fear losing their autonomy.
As of December 1, Bill 15, which proposes to renew the framework for the health and social services system in Quebec, will come into force. It will bring major upheavals in the governance of midwifery services in the province.
For example, midwives will inherit their own department, but this will be under the authority of hospital medical directors. In addition, while they currently run their own professional council, midwives will have to join the council formed by doctors, pharmacists and dentists from December.
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Julie Pelletier, president of the Order of Midwives of Quebec.
Photo : Radio-Canada
For the first time in our history, we are going to be under a hierarchical model. […] We will have to remain vigilant, because the visions of midwives and those of the medical profession are different, and we must avoid contamination. [des points de vue]supports Julie Pelletier, president of the Order of Midwives of Quebec.
The risk is to lose a little of the voice of midwives […]This is a fear that exists, which comes to us from the history of the integration of midwives into the health system, which has not always been easy.
A quote from Julie Pelletier, president of the Order of Midwives of Quebec
In Quebec, there are just over 300 midwives. However, only 5% of pregnancy follow-ups were carried out by these professionals in 2023, a marginal number, acknowledges Josyane Giroux, president of the Regroupement Les sages-femmes du Québec.
Ms. Giroux emphasizes that with the new governance structure, the heads of the midwifery department will have to sit at a discussion table composed mainly of physicians. It will be necessary to ensure that there are no losses but only gains for midwives. [et] especially for the population that requests our services.
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Josyane Giroux, president of the Quebec Midwives Association
Photo : Radio-Canada
The other issue, she says, will be to demystify the work of midwives.
The reality is that our profession is little known in Quebec. We will need openness on both sides, but especially on the part of doctors, believes Ms. Giroux.
A recent survey by the Quebec Public Health Association reveals that only a quarter of Quebecers know that this service is covered by health insurance. Furthermore, three-quarters of them do not know that a university degree is required to practice this profession.
More credible in the eyes of people
This new governance brought about by the reform of Minister Christian Dubé could make the health system even more inefficient, believes the president and CEO of the Council for the Protection of the Sick.
I don’t understand why we are putting even more pressure on doctors or medical directors when we were supposed to decentralize. [la gestion].
A quote from Paul Brunet, Chairman and CEO of the Council for the Protection of the Sick
Mr. Brunet also believes that this new structure could lead to the devaluation of the profession of midwives.
It is as if these women do not have the skills and as if they are not already subject to professional rules. They are responsible for their actions like any other health professional.
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Paul Brunet, Chairman and CEO of the Council for the Protection of the Sick.
Photo : Radio-Canada
We will attract more women to hospitals, but we are supposed to free up hospitals. We are doing exactly the opposite of what the minister wants, he adds.
As for the College of Physicians, it emphasizes in an email that what matters to it is that during childbirth, the care provided to women and infants is safe and of quality, regardless of the health professional who provides it.
Despite the fears raised by some midwives, Elizabeth Tailly, head of midwifery services at the Maison de naissance du Fjord-au-Lac, is rather positive about this new governance.
What is unknown is the new relationship that will have to be built with the medical director. And it is a relationship that will be built over the long term, says Ms. Tailly, who will become the head of the midwifery department in Saguenay starting in December.
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Elizabeth Tailly, head of midwifery services at the Fjord-au-Lac Birth Center.
Photo : Radio-Canada
As head of department, Ms. Tailly’s responsibilities will include setting up the department, writing operating rules and supporting her clinical team.
Having a department will allow midwives to take a more strategic position, more credible in the eyes of people. We will be able to deploy our operating rules, our care rules. Our unique character will remain.
A quote from Elizabeth Tailly, head of midwifery services at the Maison de naissance du Fjord-au-Lac
There is no advantage in developing a department of midwives that is identical in character to what is done on the side of doctors or nurses.
Lack of awareness of our profession persists, but I am confident that midwives will continue to carry the torch, despite the changes, she concludes.
With information from Elyse Allard
