The Regroupement Les sages-femmes du Québec (RSFQ) works to develop the profession and its specificity within the Quebec health system. In accordance with the philosophy and standards of practice of the profession, it defends the choice of birth place:
The mission of the Regroupement Les sages-femmes du Québec (RSFQ) is to defend the professional, economic and social interests of its members.
Midwives are also members of the Quebec College of Midwives (OSFQ), which oversees the profession. The OSFQ ensures public safety and monitors the quality of services. It assesses the skills of midwives, the organization of care, as well as the relations with other professionals.
The model of midwifery practice is based on the following guiding principles:
More specifically, the philosophy of midwifery practice, adopted by the RSFQ in 1997, is defined as follows:
“The practice of midwifery is based on respect for pregnancy and childbirth as normal physiological processes, carrying deep meaning in the lives of women.
Midwives recognize that labour and birth belong to women and their families. The responsibility of health professionals is to provide women with the respect and support they need to give birth in safety and with dignity.
Midwives respect the diversity of women’s needs and the plurality of personal and cultural meanings that women, their families and their communities attribute to pregnancy, birth and the experience of new parenting.
The practice of midwifery is exercised within the framework of a personal and egalitarian relationship, open to the physical, social, cultural and emotional needs of women. This relationship is built on the continuity of care and services during pregnancy, childbirth and the postnatal period.
Midwives encourage women to make choices about the care and services they receive and how these services are delivered. They consider the decisions as resulting from a process where responsibilities are shared between the woman, her family (as defined by the woman) and health professionals. They recognize that the final decision rests with the woman.
Midwives respect the right of women to choose their healthcare professional and the birthplace, in accordance with the standards of practice of the Quebec College of Midwives. Midwives are ready to assist women in the birthplace of their choice, including their home.
Midwives consider the promotion of health to be essential in the maternity cycle. Their practice is based on prevention and includes a judicious use of technology.
Midwives consider the interests of the mother and her unborn child to be related and compatible. They believe that the best way to ensure the well-being of the mother and her baby is to focus their care on the mother.
Midwives encourage family and community support as the preferred means of facilitating the adjustment of new families.”
As the profession of midwifery has its roots deep in history, it is difficult to depict all its ramifications. Let us briefly retrace the evolution of the profession in Quebec since the 1970s.
For many reasons, the mid-1950s witnessed an exodus of childbirth from homes to hospitals. Since the introduction of hospitalization insurance in 1962, 95% of women give birth in hospitals.
At the same time, we are witnessing an “industrialization of childbirth” as well as the “care” of pregnant women and women giving birth: labour management, Friedman curve, analgesia, restraint, general anesthesia in the second stage of childbirth, episiotomy, forceps, separation of mother and newborn at birth, nursery, artificial feeding…
A movement critical of obstetrical practice and overmedicalization began in Quebec. Childbirth then takes place passively, which is due to the use of general anesthesia, practised on 37% to 89% of women, depending on the region.
As a result, women decide to give birth at home; often alone, but sometimes guided by women able to help them. Self-taught or empirically, some of these practitioners became those we now call midwives. Some others had obtained training abroad or in Canada and had already practised in developing countries or in territories outside of Quebec.
The Association pour la santé publique du Québec (ASPQ) organizes conferences “Accoucher ou se faire accoucher” (giving birth or undergoing delivery) in all regions of Quebec, mobilizing approximately 10,000 people. Two important recommendations are made: the legalization of midwives and the establishment of birth centres.
Quebec midwives come together.
The interdepartmental committee on midwives, chaired by the Quebec Ministry of Education, recommends legalizing the practice of midwives.
The midwives founded the Alliance québécoise des sages-femmes praticiennes (AQSFP). They organize the practice, give themselves standards of practice, a code of ethics, files, a complaints and discipline committee, a peer review procedure, etc. Not only do they structure the practice of midwifery, but they also lay the foundations for the organization of their profession.
The Rochon Commission acknowledges the relevance of integrating midwives into the Quebec public health network.
Bill 4, allowing the experimentation of midwifery practice in pilot projects, is adopted unanimously in the National Assembly. The Ministère de la Santé et des Services sociaux (MSSS) invites health and social service centres (CLSC) to present pilot midwifery projects.
Two ministerial committees, i.e. the midwifery admissions committee and the pilot project evaluation committee, work on the evaluation of midwives and pilot projects.
Compared to Ontario, which directly legalized the midwifery profession in 1994, Quebec, among others, under pressure from medical associations, must go through the evaluation of the profession via pilot projects.
After more than fifteen years of activity, the Alliance québécoise des sages-femmes praticiennes (AQSFP) dissolved, as did the Association des sages-femmes diplômées du Québec to create the Regroupement Les sages-femmes du Québec (RSFQ).
The government publishes ministerial recommendations calling for the legalization of midwives and the development of the practice in the various birth settings (home, birth centre and hospital).
The Midwives Act is finally adopted. Midwives are officially recognized as autonomous professionals in Quebec. It was this same year that university training for midwives began at the Université du Québec à Trois-Rivières.
The Quebec College of Midwives (OSFQ) officially begins its mandate.
A first agreement was signed between a hospital (LaSalle hospital in Montreal) and a birth centre (Lac Saint-Louis birth centre), allowing women to give birth in the hospital accompanied by a midwife.
The MHSS signs an agreement with the RSFQ.
Professional insurance now allows midwives to go and assist a woman at home.
Le MSSS publie sa Politique de périnatalité 2008-2018.
The RSFQ signs a service agreement with the Fédération des Professionnèles de la Confédération des syndicats nationaux (FP-CSN) in order to benefit from its expertise as well as the support of the central councils of the CSN.
The Coalition pour la pratique sage-femme is relaunched.
The filing of a petition by the Coalition pour la pratique sage-femme leads to important recommendations from the Committee on Health and Social Services [PDF] regarding the development of midwifery.
The compensation of midwives is re-evaluated following a pay equity review.
Requests from the RSFQ relating to the renewal of the agreement with the MHSS are submitted.
The Commissaire à la santé et au bien-être (CSBE) submits its report on the performance of the health and social services system, a report on perinatality and early childhood in Quebec (Rapport d’appréciation de la performance du système de santé et des services sociaux : État de situation : portrait de la périnatalité et de la petite enfance au Québec).
L’Institut national d’excellence en santé et en services sociaux (INESSS) publie un rapport intitulé Mesures prometteuses pour diminuer le recours aux interventions obstétricales évitables pour les femmes à faible risque.
The MHSS and the RSFQ sign their second agreement, after a long and complex process, namely that of the complete rewriting of the first agreement. For the first time, midwives were supported by the FP-CSN, and united in the fight for their working conditions in unprecedented negotiation and mobilization.
Adoption by the National Assembly of Bill 10: Act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies. The councils of midwives lose their seat on the boards of directors of the establishments, unlike the CPDP, CII and CM, thus contributing to the marginalization of midwives and making the work of the professional council of midwives more difficult.
Launch of the Cadre de référence pour le déploiement des services de sage-femme au Québec (Reference framework for the deployment of midwifery services in Quebec) by the MHSS on May 5, 2015, on the occasion of the International Day of the Midwife, a highly anticipated reference document to support development.
Publication of a cost analysis: delivery with midwives or doctors by the firm MCE Conseils on the occasion of the International Day of the Midwife. The results of this cost comparison study show that pregnancy and childbirth monitoring by a midwife costs 25% less than with a doctor.
