TORONTO, December 17, 1997 -- A postdoctoral researcher with York University's Centre for Health Studies has been awarded one of only four National Health Postdoctoral Fellowships to research how midwifery is being integrated into the Canadian health-care system.

Dr. Ivy Bourgeault was granted the $60,000 two-year fellowship by Health Canada's National Health Research and Development Program for a project that will look at how the role of midwives in the health-care system is being altered by midwives' integration into hospitals, a new education program for midwives, and changes in health-care funding structures. Her research will focus primarily on Ontario, but will also examine other jurisdictions within Canada and around the world.

Bourgeault is the first postdoctoral fellow at York University to receive the prestigious fellowship, which is usually awarded to institutions affiliated with medical schools. Her work is linked to other research on women, work and health-care restructuring underway at York's Centre of Excellence for Women's Health Research (one of five Canadian centres funded by Health Canada).

"This Fellowship provides me with the opportunity to continue my work in what has, up to recently, been a very under-researched area," said Bourgeault. "I hope my research will offer important insights into the intense change underway in the midwifery profession. As more and more parents choose to give birth with the guidance of a midwife, and as the profession becomes more mainstream, we need to evaluate how the people and institutions that deal with midwives are changing too."

Prior to 1993, midwives acquired their skills through informal apprenticeships, and were not regulated as a profession. In September, 1993, Ontario's first midwifery baccalaureate program began at Ryerson Polytechnic University in Toronto, Laurentian University in Sudbury, and McMaster University in Hamilton. In December of the same year, midwifery became a regulated profession in Ontario, through the passage of the Midwifery Act.

Bourgeault's research follows up on her PhD thesis work, which looked at this process of formal integration into the health-care system. But now, she wants to examine what is happening post-integration. "For example, are doctors, nurses and other hospital employees embracing the arrival of midwives into hospitals? Or do they see them as intrusive?" asks Bourgeault.

Bourgeault will also examine the role of the education system in the "mainstreaming" of midwifery, through the development of a formal university curriculum for aspiring midwives. "One major issue now is how to deal with the demand for midwives, and in turn the demand for places in universities where people can train," said Bourgeault. The Ryerson-McMaster-Laurentian program currently accepts only 30 out of 400 applicants every year.

Bourgeault will also look at how formal education for midwives may affect some of the traditional philosophies that underpin the profession: the belief in informed choice and shared decision-making, home birth and the need to de-medicalize birth.

The study will also look at changes in the way midwives are paid. When the profession became regulated in 1993, midwifery began to be paid for by the provincial government through a central funding agency that paid midwifery practice groups (groups of midwives) according to their birth caseload. As of the end of March, 1998, the money for funding midwives will be administered at the local level, through local transfer payment organizations such as community health centres.

"The changes in funding structures may be pivotal in influencing the direction of the profession. Local administration of funding may serve to erode midwives' common philosophies and practices -- despite the fact they will still have to answer to the College of Midwives of Ontario -- because local funding agencies may impose standards above those of the College," said Bourgeault.

Bourgeault's research will be conducted in two parts: through the analysis of a wide range of documents such as correspondence, newsletters, transcripts, medical journals and newspapers, and through extensive and repeated interviews with midwives, government representatives, educators, obstetricians, pediatricians, family doctors, anesthesiologists, nurses, and hospital administrators and midwifery students.

The project will be complete by the end of June, 1999. Bourgeault intends to use her findings, as well as the results of her doctoral thesis research, to write a book about midwifery in Ontario. She will also present the results of this project at various academic conferences and in journal articles.

For more information, please contact:

Dr. Ivy Bourgeault
Centre for Health Studies
(416) 736-5941
email: ivyb@yorku.ca

Sine MacKinnon
Senior Advisor for Media Relations
(416) 736-2100, ext. 22087
email: sinem@yorku.ca

Alison Masemann
Media Relations Officer
(416) 736-2100, ext. 22086
email: masemann@yorku.ca
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