Meet 3 London-area midwives working to drive positive change in Ontario's health-care system

A group of midwives in southwestern Ontario joined together for a week-long convention, in which they shared their professional experiences, discussed research, and how their skill sets can serve the unique needs of birthing parents and their newborns. 

Three of those midwives shared with CBC London the work they're doing to innovate the way midwifery operates within the health-care system and improve collaborations with other health care providers.

Meagan Furnivall - Burnout in midwifery

Registered midwife Meagan Furnivall is the clinical department lead at the London Health Sciences Centre (LHSC). Her research with King's University College professor, Andrea Lawlor, centres around burnout in the profession, and how stressors can be minimized to maintain a consistent workforce. 

"Burnout's pretty prevalent in midwifery. We set out to look at how COVID impacted it," she said. 

The findings surprised Furnivall, she said. Although midwives already reported feeling moderate levels of burnout before the pandemic, COVID exacerbated the underlying issues around it, Furnivall found.

The biggest contributor to burnout was the on-call model of care, requiring midwives to work around the clock, when someone goes into labour, Furnivall said.

"Issues around work-life balance are difficult especially for those with care-giving responsibilities, so children or parents to take care of," she said. 

"They've said 'This cookie-cutter model is really difficult and it's making it so I have to leave the profession because I can't work in this capacity', which is a huge economic loss to the community as well as a clinical loss."

Midwives would prefer shift work or working in different settings like clinics focusing on newborns, contraception, or reproductive issues, Furnivall said. 

When Furnivall's department received funding from the Children's Health Foundation almost three years ago, she was tasked with building capacity to do research about midwifery that would ensure midwives are better equipped to do their jobs. 

This research can help midwives keep up with clinical research and better advocate for their patients. Furnivall will conduct similar research on burnout on a provincewide level as well. 

Ellen Blais - Creating an Indigenous focus

Bringing midwifery back to communities is a priority for Ellen Blais from the Oneida Nation of the Thames and director of Indigenous midwifery for the Association of Ontario Midwives. 

"For generations, we had midwives in our community and no doctors, but with medicalization of childbirth and taking it out of community, the system was imposed on us," she said. 

Blais heard from many pregnant people living in their communities, especially those in northern Ontario, who have to fly south just to access a hospital to give birth.

"We don't see that in the well-resourced communities where people go to hospitals and bring home their babies. That's not the case for Indigenous people," she said. 

Blais, who was adopted into a non-Indigenous family as a result of the Sixties Scoop, believes community and culture directly impact one's identity, and it's important to make systemic changes so that childbirth can feel like a joyous experience, instead of a fearful one, she said. 

"We know that many Indigenous people experience racism within the health-care system," she said. "Indigenous midwives have the capacity to be with the woman, advocate for her needs, and navigate the system for her."

Blais is working with the Ministry of Health to change policy to support Indigenous midwifery and enhance education for Indigenous people considering the profession. 

Lauren Columbus - Teamwork in birthing units

Improving communication among teams on birthing units is important for LHSC midwife Lauren Columbus. She believes this can result in a healthier work environment and better patient outcomes.

Columbus' research analyzes how approachable people at the top of the care team hierarchy [usually physicians] truly are, and how they can create an environment in which other professionals such as nurses, midwives, or medical students can feel comfortable voicing opinions or pointing out errors, placing patient safety at the forefront.

"The way that people are treated and spoken to by their colleagues really plays a big role in burnout and their eventual reasons to leave a workplace or profession completely," she said.

"Obviously if you feel like you're a valued team member at work, you have that psychological safety where if you make an error or suggestion, it's not going to be held against you."

A simulated study done by Columbus' team found that doctors weren't challenged by others on their team on certain decisions or errors. It prompted them to reflect on how to foster a safer environment. 

"Building blocks include time and presence," Columbus said "Being more accessible for people to ask questions, showing vulnerability and being able to admit mistakes models that for other team members."

In the ten years she's practiced, she's noticed a subtle culture change where birthing teams are becoming more collaborative, Columbus said. She hopes the hierarchical approach to childbirth can eventually be dismantled and relationship building can be emphasized.