Amid bid for better pay, Hamilton midwife explains her job

Six hundred and eighty-one Ontario midwifes are arguing for equal pay, after nearly 20 years of minimal salary increases from the province.

Hamilton midwife Christine Sandor, 29, is one of them.

Last Wednesday, Ontario's midwives took legal action against the Ministry of Health and Long-term Care over pay equity and filed a complaint with the province's Human Rights Tribunal.

It calls on the province to double their pay, to almost $200,000 per year, close to what a family doctor makes. In 1994, the province set a midwife's pay in between a community-health physician and a nurse practitioner, said Sandor. She is a member of the Community Midwives of Hamilton.

Since then, midwives have only seen a 33-per-cent salary increase, whereas physicians and nurse practitioners have received a 74-per-cent increase, despite the fact that midwives' scope and responsibilities have expanded during the near-20 year period.

The Ontario Association of Midwives also argues that gender has played a role in the lack of pay compensation – midwifery is largely dominated by women.

Each midwife help delivery up to 80 babies a year. They're on-call 24 hours a day.

Sandor spoke to CBC Hamilton about what her job is like, the personal sacrifices she makes for her work, and why this human rights case is important.

What is a typical day in midwifery like?

Each day is completely different, but in a typical week, we would have one or two days where we'd have clinic, so doing pre-natal appointments for clients. We do all the prenatal care someone would need when they are pregnant. We'd do all their routine blood work and physicals, screening test and ultrasounds. We also do postpartum visits for moms and babies for up to six weeks.

Another typical day, we would be called to a birth and be with someone in labour and delivering their baby during the day or during the night, whenever we are called.

Sometimes we also do home visits, so we're driving around to people's houses to do visits usually for the first 10 days to two weeks that they're home with their new baby.

We're on-call 24 hours a day. In general, we're on-call for the better part of the week, so sometimes we're in clinic and have to run out to a birth and sometimes it's quiet.

Your work is entirely unpredictable. How has that affected your personal life?

I always tell midwifery students that if you think it's going to be a job where you go to school, become a midwife and that becomes the job you come home from, it's not going to be like that. It does affect your friends and family.

Learning to live on-call for most of the time that you're working is something that takes practice, because you need to get used to cancelling plans and your friends and family have to get used to you being not as reliable as you used to be.

I don't have kids right now, but midwives with kids have to have 24-hour, on-call child care organized if they have a partner who is working also. That's another aspect of our job that's different from other health care providers.

What would a clinical appointment with a midwife look like compare to that with a doctor?

Usually the first and second appointments with our client are an hour long, so we go through the model of midwifery care, how our practice is set up, health history, a physical, blood work and then after that our appointments are half an hour long.

Those appointments, we'd do the regular clinical things you'd do at your family doctor and then there is time for discussion about what's happening during pregnancy, so moms and families understand this is, for example, the blood test I'm recommending and these are the risks.

I want to make sure they have an understanding of what is happening during their care. It would be pretty unusual for me to say, 'hey, go for this blood work' and you don't understand why you're going.

One thing that midwifes and the people we work with really appreciate is the relationship we're able to build throughout their pregnancy. So by the time they're ready to have the baby, we know what the expectations are for the birth and what our recommendations are.

Do you feel you've been underestimated on the job?

In Hamilton, there is a really excellent relationship between the physicians, nurses and health care providers we interact with. In that sense, I don't feel like my skills are looked down upon.

In talking to people who aren't as exposed to midwives or in communities with an established midwifery presence, it can be much more challenging. I think a lot of that stems from not understanding what our scope is, not knowing what our education is, what's involved in the care we provide. There is a lot of misunderstanding still, even within the health care field. 

Do you agree with the argument that the Association is making about pay inequity, that it's because midwifery is a female-dominated profession?

That's part of it. Now there are a greater proportion of females in the medical profession as physicians, but midwifery is the most female-dominated profession in Ontario.

We provide care only to women, who are healthy, so that's another part of the gender piece. It's a very unique career, It's basically all women providing care to primarily women.

The main point that's important to make is that we're not seeking to double our salaries just for the sake of it. We want to be paid equitably in the way the government determined we should be paid 20 years ago.

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