Valuing midwives: Providing care to the most vulnerable

Pictured above: Midwives Simone Rosenberg and Christie Lockhart and their clients meet with MPP Stephanie Bowman at the Midwives of East York - Don Mills clinic, October 2023

This month, as part of the Valuing Midwives Campaign, midwife Simone Rosenberg met with her local Member of Provincial Parliament (MPP), Peter Tabuns. She and her midwife colleague Christie Lockhart also hosted Stephanie Bowman MPP at the Midwives Clinic of East York - Don Mills, introducing her to clients who spoke highly of their experiences with midwives at the practice group.

These meetings gave Simone an opportunity to discuss the role midwives play in providing care, including to pregnant people without health insurance. Midwives Clinic of East York provides care to over 700 pregnant people and their families each year. Of those, about 10% are people without health insurance. The May 2023 Health Network for Uninsured Clients (HNUC) Report (PDF, 1 MB) conservatively estimates there are currently upwards of 500 000 people living in Ontario without health insurance.

Midwives Clinic of East York has a satellite team of midwives working at Women’s Health in Women’s Hands Community Health Centre, exclusively serving racialized, uninsured people in downtown Toronto.

Reasons a pregnant person might not have health insurance vary, including but not limited to insecure immigration status, homelessness, poverty and struggles with mental health or addictions. Some may have documents withheld by an abusive partner or employer. An increasing number live and work with precarious immigration status, some because of an increasingly complex immigration system, others because of backlogs and longer processing times. Many are between applications with ever-longer waiting periods – as one permit expires, they fall “out of status” waiting for another to be processed. Many of these pregnant people speak little to no English, live in extreme poverty and have few resources.

Midwives are well positioned to provide care for pregnant people without insurance, and midwifery is funded for anyone residing in Ontario, regardless of immigration status.

At the meetings with MPPs Tabuns and Bowman, Simone stressed the importance of providing care to pregnant people without health insurance from both a quality and a cost-saving perspective. People without insurance, including those who are pregnant, are often treated poorly or ignored in the health system. Midwives like Simone provide newcomers and their families with primary care health services during their pregnancies, labour and birth, and the six-weeks following the birth, and often act as the bridge connecting clients to additional services.

Research shows that pregnant people who are uninsured access care less often and later in pregnancy, which can increase the risk of preterm birth and low birth weight babies. The care of babies born too early and too small is among the highest of all health-care expenditures in Canada. Babies born too small and too early need highly specialized medical services and often have lifelong consequences with brain and body development. Insufficient access to prenatal care results in higher risk pregnancies.

People without adequate prenatal care are more likely to access the emergency departments in hospital. Patients who show up to emergency department in crisis will have no records, are often sicker than they would have otherwise been and need a higher level of care more urgently. This adds stress to an already strained clinician pool. Preventing pregnant people from unnecessary emergency department visits requires preventative care at the right place and at the right time.

Midwives offer a cost-effective intervention that supports the birth of healthy babies and provides quality care, especially to vulnerable populations such as people without health insurance. Midwives like Simone provide care so that clients without insurance don’t end up in emergency departments.

Throughout Simone's meetings with MPPs Tabuns and Bowman, her message was clear: Midwives are an important part of the health system in Ontario, providing quality and cost-effective care, including to some of Ontario’s most vulnerable residents.

Want to know more about the Valuing Midwives campaign? Email Ifra Zahid, Policy Analyst, at ifra.zahid@aom.on.ca.