A series of recent events have unfairly cast a negative light on the practise of midwifery in Ontario, particularly in the Kitchener/Waterloo region.

First, local midwife Mary Molnar agreed to stop practising after the College of Midwives of Ontario (CMO) cited her for “incompetence and professional misconduct.” Then, legendary retired midwife Elsie Cressman was ordered to pay $3.5-million dollars as compensation for alleged malpractice, in a birth that occurred sixteen years ago.

It would be unfortunate if these events led even one local woman to reject midwifery as an option for care during pregnancy and childbirth. Midwifery continues to be a safe alternative for women and for babies.

In 1991, Ontario became the first jurisdiction in Canada to give legal recognition to midwives and to implement a degree program for accrediting them. Midwifery became formally recognized as a profession, regulated and funded by the province at the end of 1993.

Thus, when our first child was born at home in 1992, we gladly paid for the services of our midwives. By the time that our second child arrived in 1994, the service was fully covered by the Ontario Health Insurance Plan (OHIP). (For this reason alone, itâe(TM)s not exactly true to say, therefore, that the only legacy of the Bob Rae New Democratic Party (NDP) government was “casino gambling and a private Highway 407” — as Toronto Star columnist Thomas Walkom cruelly observed in April.)

Midwives believe that pregnancy and childbirth are “normal, healthy events in a woman’s life” and see the role of midwives as “guardians of normal childbirth”.

The Association of Ontario Midwives (AOM) points out that “midwifery care reduces the incidence of interventions such as caesarean sections, epidural anaesthetic and episiotomies, resulting in savings to Ontario’s health care system and hospitals through lower operating room time and drug costs.

These savings offer opportunities to reinvest health care resources at the community level. Reduced dependence on in-patient care represents a significant savings for the health care system and hospitals. Currently in Ontario, 30 to 35 per cent of midwife-assisted deliveries take place in the home, representing the lowest cost option for healthy deliveries.”

In addition, “midwifery care is more than delivering babies. Midwives counsel, monitor and support the health of the mother from early in the pregnancy, through birth and the post-partum period. Continuity of care is an important aspect of midwifery care. The time midwives spend in education and support is an essential part of lowering rates of intervention.

Midwives help minimize complications by providing at least three home visits in the first week post-partum to monitor the progress of the mother and newborn. By discussing nutrition and other health issues with the family, midwives help reduce hospitalization in the post-partum period.

Rates of readmission of newborns to hospital for such things as dehydration or jaundice are reduced. Midwife-assisted births have proven health benefits, including higher rates of successful breastfeeding and earlier breastfeeding.”

I know Mary Molnar only by reputation and haven’t read the complete judgement against her, so I won’t presume to defend her methods of care. But it seems to me the judgement against her is evidence that the self-regulatory nature of midwifery is working.

I also know that it is exceedingly rare for Ontario physicians to lose their licenses to practise — even when they are found to have committed far greater transgressions than Molnar was found to have committed.

I do know Elsie Cressman well, as she and her niece Evelyn (also a licensed midwife) “caught” both of my children. And I think it is unfair and unreasonable to consider the verdict against Elsie Cressman (which is now under appeal), without considering the legal context of the time.

In 1986, Ontario’s midwives practised in a sort of legal vacuum. They were not expressly illegal but were often treated by the health care system as if they were.

Elsie relates how she used to take women who were experiencing complications in their delivery to the hospital, and because midwives were banned from the hospital — by doctors protecting their turf — leave them at the elevator door.

In spite of these obstacles, Elsie persevered with her pioneering efforts to gain greater acceptance for midwifery. These efforts were essential in allowing us to exercise an informed choice to introduce our daughters to the world in the safe and familiar environment of our home.

We were so impressed with Elsie as a caregiver and as a human being that we nominated her for the Ontario of Ontario honour that she proudly wears.

When she retired in 1998, hundreds of parents and healthy happy children crowded into Elsie’s retirement party to wish her well.

As she reflected after the judge’s harsh verdict, “You take the bitter with the sweet. I’ve had so much gratitude that I guess I can take one bad thing.”

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Scott Piatkowski

Scott Piatkowski is a former columnist for rabble.ca. He wrote a weekly column for 13 years that appeared in the Waterloo Chronicle, the Woolwich Observer and ECHO Weekly. He has also written for Straight...