Delivering the 'new' Canadian midwifery: The impact on midwifery of integration into the Ontario health care system

Abstract

This paper addresses the impact on midwifery of its recent integration into the provincial health care system in Ontario, Canada. Data are derived from participant-observation, primary and secondary source documents, and key informant interviews. Based on these data, I argue that midwifery has changed throughout the integration process but it has also successfully resisted change. Specifically, the organisation of the midwifery community evolved from an amorphous social movement to a more bureaucratically organised profession. The regulation of midwifery also shifted from direct-regulation by clients to professional self-regulation. The educational model of midwifery also changed from an eclectic apprentice-based approach to a more standardised baccalaureate degree programme. The midwifery model of practice, however, was sustained. Although these changes occurred at the hands of key members of the midwifery community, they were made in response to the structural context of the health care system into which they were attempting to become integrated.