The development and implementation of regulated midwifery in Manitoba was an enormous undertaking. Its history begins in the early 1980s and even before that, when women first began to reclaim their births and found other women who could help them do so. My own involvement began in the mid-80's, first as a mother seeking a midwife's care, and then as Chair of the Equity and Access Committee of the Midwifery Implementation Council. I worked in that capacity for over 5 years, as well as on other committees, until the College of Midwives of Manitoba opened for "business", when I became the first Registrar.

It is not possible to cover all aspects of the many pieces that contributed to the eventual Proclamation of the Midwifery Act in 2000 in anything less than a book. Besides the involvement of the Midwifery Implementation Council, there was a concentrated effort within Manitoba Health to see the work to completion. There was also good political will across the board - the Bill sailed through all readings, with all parties signing on without debate!

This paper gives only a mere overview, developed in keeping with the theme of the Working Symposium, Midwifery: Building Our Contribution to Maternity Care (Vancouver, 2002). I wish to thank my colleague, Yvonne Peters, who contributed a great deal to this paper, which we delivered in an alternative way in Saskatoon in 2001.

Margaret J. Haworth-Brockman
Executive Director
Prairie Women's Health Centre of Excellence

Introduction

In 1994 the Minister of Health for Manitoba announced the formation of the Midwifery Implementation Council. The Council consisted of 13 hand-picked women who were given 2 and a half years to put into effect the recommendations from a Working Group Report which was released on the same day. Six years later, in June 2000, the Manitoba Government proclaimed the Midwifery and Consequential Amendments Act which identified midwives as autonomous health care providers. Coincidentally the Manitoba Government confirmed the mechanisms to make midwifery care available as a funded service for women, including the means for payment to midwives and for collaboration with other health care providers.

The presentation will examine some of the steps taken, and the successes and challenges of making midwifery care available to women, particularly for those who live outside of Winnipeg. The presentation will include a brief outline of the policies in place, and the struggles to implement those policies in rural and remote Manitoba because of challenges in human resources (recruitment and retention), local acceptance, providing culturally appropriate care and so on. Finally the presentation will identify the need for further research and evaluation of the true availability and accessibility of midwifery as a primary health care service in rural and remote Manitoba, including women's satisfaction with the newly-regulated profession.