Regulating and Funding Midwifery in Nova Scotia

Midwives have been working in Nova Scotia for many years, and midwifery became a government funded and regulated health profession in the province in 2009. Despite the will among many decision-makers in the province to regulate the profession since the mid 1980s, several elections and lack of a management model slowed the program’s development. Implicit goals of having midwifery services included improving the quality of maternal care and health outcomes, keeping up with other provinces, responding to public demand, and saving costs. Strong and persistent bureaucratic and public advocacy work, inter-party collaboration, and research demonstrating positive and safe maternal and newborn health outcomes under midwifery care all had a role in the decision-making process. The implementation responsibility was delegated to three health districts in the province, each being responsible for designing a program to integrate midwives into maternal health care teams. The program has thus far been evaluated in an ad hoc manner with external teams performing comprehensive assessments, though the need for a cost-benefit analysis as well as more systematic assessments has been identified. Though many opportunities exist with midwifery in the province, including a continued high demand for the service, and research demonstrating positive outcomes for mothers and babies, significant challenges and threats remain to be addressed to ensure long-term sustainability of the program.