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Association of Ontario Midwives 2018 Annual Report

Message from the President and Executive Director

In 2018, the collective effort of midwives, channeled through a strong and effective association, made important contributions to developing the profession of midwifery; promoting the health of families, newborns and communities and to championing gender equity and social justice.

We are pleased to present to you the highlights of what we have accomplished in 2018 in this annual report. As you’ll see, our work has made important in-roads into the four prongs of our strategic plan:

The Restoration and Renewal of Indigenous/Aboriginal Midwifery

A Strong, Equitable, Integrated & Valued Midwifery Profession

Flexibility to Provide Sustainable Care & Innovation to Meet the Diverse Needs of Communities & Midwives

Advancement of Client-Centred Midwifery Clinical Excellence

Midwifery is healthy and growing. By the end of 2018, our membership reached a total of 923 midwives, including 70 newly registered midwives. Three new midwifery practice groups were established, making a total of 92 practice groups and 23 satellites across Ontario. New practices led by Indigenous midwives working under the Aboriginal exemption in the Midwifery Act flourished. Community health centres and Aboriginal Health Access Centres set up midwifery programs and hired midwives into their fold. We underwent governance changes that enable appointment of positions in order to increase diversity among our leadership.

Additionally, 2018 marked the second year of new funding mechanisms that provided for Indigenous-led midwifery, Expanded Midwifery Care Models (EMCMs), and the provision of additional services to meet community health needs. Five new EMCM programs, including a midwife-led unit in a hospital and midwifery employee positions in community health centres were established.

Despite our successes and contributions to health care, our deeply skilled and expert work is still too often undervalued. We face persistent challenges in a health care system that still limits our scope of practice. Despite our historic pay equity win at the Human Rights Tribunal of Ontario, government has chosen to appeal the decision, instead of working in partnership to close the pay equity gap.

June 2018 also witnessed a major political upheaval in our province and with it rapid and profound changes to the health care system.

Together, and rooted deeply in our values, we persist. We hope you take comfort in the small but mighty force that are midwives as you read about what we have accomplished together. We know we have so much more to do and we know that we’ll accomplish it, in time, together.

We are grateful to the midwives who provide leadership, whether in their practices or at the AOM. Midwifery volunteers are at the heart of our work, whether they are supporting the development of quality peer-reviewed clinical practice guidelines, quality improvement standards, drafting policy statements and submissions, or whether they are, most importantly but perhaps most hidden, responding to a page in the middle of the night.

In strength and solidarity,

AOM President Elizabeth Brandeis, RM, MSc and Executive Director Kelly Stadelbauer, RN, BScN, MBA
Chelsey Bouchard kisses her youngest son, Biiwaabik Bouchard, at the Six Nations birth centre. Photo credit to Deborah Baic for the Globe and Mail.

2018: Accomplishments and Highlights

Restoration and Renewal of Indigenous Midwifery

Indigenous midwifery leadership continues to advance midwifery care and improve health outcomes for newborns, parents and families. The AOM secured professional liability insurance for students working under the Aboriginal midwifery exemption in the Midwifery Act and supported strategic thinking about education pathways into midwifery for Indigenous students. We supported the establishment of funded midwifery in many communities, including in Kirkland Lake, New Liskeard, and Timiskaming. Our collaboration with the National Aboriginal Council of Midwives (NACM) helped build awareness of Indigenous midwifery and extend our advocacy to the federal level.

We supported advocacy, including a community meeting in Moose Factory, to curb attempts to return to the routine evacuation of pregnant women out of Attawapiskat for birth. We worked with midwife Christine Roy to gather support from community members and to ensure that their support for birth in the community with midwives was respected. As a result of this advocacy work, the choice to birth in community has been protected.

Indigenous Cultural Safety Training for staff, volunteers and midwives

Staff and Board of Directors participated in workshops and on-line training that expanded their understanding of Indigenous cultural safety and the colonial narratives that inform dominant attitudes in Canada today.

A historic HRTO win

Midwives received a historic decision at the Human Rights Tribunal of Ontario on September 24, 2018. In the decision, the HRTO ruled that the Ministry breached the Human Rights Code in setting midwifery compensation. Our legal team, led by Mary Cornish and Adrienne Telford, worked tirelessly to hold government accountable and to close the pay equity gap for midwives.

The Tribunal found government had discriminated against midwives based on gender. The Tribunal validated what midwives know: that the gender trifecta - gendered workforce (largely women), providing gendered care (to women and trans people) for gendered health issues (pregnancy, labour and birth) – had led to a pay equity gap. This historic and landmark ruling was celebrated by midwives and allies across our province, country and the world, including with a celebration on the lawn of Queen’s Park on September 26. We continue to work for equal pay for work of equal value and to hold government accountable to its human rights obligations.

A successful province-wide home birth campaign

This past year we also developed new resources for Ontarians to support out-of-hospital birth. New resources for midwives and consumers were developed and provided on-line and also informed a campaign that included digital and radio ads across the province. With the goal of promoting birth at home with a midwife as a safe and responsible choice, we ran a province-wide ad campaign from March 5 to March 30, 2018. The campaign reached over 65% of Ontarians with 3,000 radio spots and 1.2 million targeted digital ads. The campaign aimed to bust myths around birth in the community with a midwife, and promote home birth as a safe option.

Home, Hospital, Birth Centre: Your birthplace options : Public facing web content

Professional development for midwives

In addition to our Emergency Skills Workshop, we offered educational opportunities, in-person educational events and accessible webinars. In addition to AOM events, the AOM's Professional Development Fund was fully utilized, assisting midwives to gain new skills and further their educational goals. Over the course of the year, 596 members applied to the PD fund to enhance their skills and pursue their educational and professional goals.

An all-day session on postpartum hemorrhage skills was piloted in Muskoka, and offered again in Kingston and Hamilton. This hybrid event included an in-person session and an eLearning. Another all-day session provided hands-on skills for maintaining primary care for induction and augmentation and included practicing the insertion of foley catheters for cervical ripening.

A valuable conflict resolution session was developed for midwives, focusing on skills for dealing effectively with conflict. This well-attended workshop provided tools and techniques to help achieve resolution and to help midwives respond effectively when conflict (inevitably) arises.

Webinars that place midwives at the centre of learning

Over 20 webinars were developed with the specific needs of midwives in mind, including varied topics such as:

  • Focus on Intrauterine Contraception for Midwifery Practice
  • Providing Care and Surrogacy
  • Group A Strep and Postpartum Infections
  • Privacy Requirements, Breaches, and Reporting
  • IPAC Implementation: Grappling with Theory and Practicality
  • Cannabis Use in Pregnancy and Lactation
  • Bullying: Structural Factors and Systemic Issues
  • Polyamorous Families' Experience with Childbearing and Birth
  • Sex and Birth Education for Midwives
  • Compassion Fatigue, Second Victims, and Burnout
  • Postdates IOL Outcomes with Various Care Providers
  • Anxiety in Pregnancy
  • External Cephalic Version: Predictors of Success
  • Supporting Adverse Diagnosis
  • The VEGA Project-Recognizing and Responding Safely to Family Violence
  • Ankyloglossia: Tongue Ties and How to Spot Them

Paramedic skills for childbirth emergencies

The AOM, in partnership with the Ontario Base Hospital Group (OBHG), developed the Paramedic Emergency Skills Program (PESP): Managing Birth Out-of-Hospital to reflect the evolving scope of paramedic practice, including the Emergency Childbirth Medical Directive and Advanced Life Support patient care standards.

The PESP is a full-day, in-person event with simulated emergency childbirth scenarios providing paramedics with the knowledge, evidence-based practice and hands-on skills to manage out-of-hospital childbirth emergencies with confidence and competence. Since the advent of this initiative, 242 paramedics have been trained.

Support for Clinical Excellence

The AOM supported midwifery led research and dispersed research grants to seven teams. A successful Midwifery Research Symposium highlighted leadership and academic rigour in midwifery across the perinatal and reproductive care spectrum.

In 2018 we awarded the Excellence in Midwifery Research Paper award to Samantha Krueger for the paper titled, "Labour outcomes after successful external cephalic version compared with spontaneous cephalic version”.

In 2018 the AOM launched this infographic highlighting outcomes from 2016-2017 BORN data.

Denouncing Bullying in Healthcare and in Midwifery

We launched a multi-pronged project to denounce bullying in the profession of midwifery starting with a position statement on bullying. The 2018 Ontario Midwifery Conference launched with a keynote address from workplace violence expert Denise Koster, a presentation on the results of the survey on bullying, a focus group with midwives on the systemic and structural factors that contribute to bullying in the profession, and a poster that midwives could sign to pledge their personal commitment to denouncing bullying. We developed website resources on bullying and formed a task force to draft a values-based code of ethics (including business practices).

Member support and AOM On-Call

Through AOM On-Call, we provided 24/7 support to approximately 240 different members in over 1 100 distinct calls.

Locum Program

In 2018, 533 days of locum relief were provided to 28 rural and remote midwives throughout Ontario. This successful and vitally important program is a step in ensuring sustainable midwifery care in many communities across the province.

Infection Prevention and Control and Support to Practices with Inspections

We developed midwifery specific resources on infection prevention and control and supported practices through public health and Ministry of Labour inspections.

“When the Ministry of Labour showed up at our practice we called the AOM for support. [AOM staff] provided us resources to prepare for the subsequent visit and ensure we met all the OHSA requirements. The inspection went smoothly, the support was invaluable. Dealing with AOM I’m always met with engaged, enthusiastic, caring and knowledgeable people who are always looking for the best outcome for our practice and clients.” - Midwifery practice partner

Quality Improvement

The AOM hosted nine regional workshops where representatives from 86% of midwifery practices discussed top risks in midwifery and their successes and challenges in quality improvement. We identified opportunities for improvement and areas where the Association can support midwives to continue to provide high quality care and excellent business practice. In response to past workshops, we released new resources, including:

Ontario Midwifery Conference 2018

We hosted a successful conference that balanced sessions on midwifery research and clinical topics by day and socializing with friends and colleagues around the campfire at night. The conference was held at the JW Marriott Rousseau resort in Muskoka- a spectacular location. We highlighted more research and practice-based content than previous years and blended learning, relaxation and fun.

Midwifery Awards

Elsie Cressman Award: Judy Rogers

Innovation has been key in Judy Rogers’ success at providing access to midwifery care for clients in Parry Sound and surrounding communities. Having relentlessly pursued her dream to keep care close to home, Judy has shared calls with the interdisciplinary team at her hospital since the establishment of Midwives of Georgian Bay in 2014.

Hospital Integration Award: Collingwood Hospital

Setting an example for well-integrated midwifery care in the hospital, Collingwood General and Marine Hospital involved midwives in decision-making and built an integrated maternity care program.

Media Award: Cathy Alex

Cathy’s article “Ontario restores 'beautiful ceremony' of birth by funding 6 Aboriginal midwifery programs” beautifully captured the impact of midwifery in Indigenous communities and the necessary work of returning birth to communities.

Social media engagement

Social media enabled us to connect with people across the province and beyond, to promote a deeper understanding of the work and contributions of midwives.

Advocacy with government and stakeholders

A determined and committed voice for midwives, we regularly engage in advocacy with government and stakeholders. In 2018 this work included input into the College of Midwives of Ontario regulations review; working with eHealth Ontario to complete a regional roll-out of the Ontario Laboratories Information System (OLIS); the first North American professional association position statement on intersex child autonomy; participation at provincial International Women's Day and Equal Pay Day rallies; and submissions to provincial government including on pay transparency legislation.

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