Delivering Midwifery: A Scoping Review of Employment Models in Canada

The majority of Canadian Provinces have regulated and publicly funded midwifery. No comprehensive review has summarized and compared the various types of employment models, practice organizations, and compensation for midwives across Canada. The aim of this scoping review was to gain an understanding of evidence related to funding models, organization of practice models, and compensation for midwives. The Arksey and O'Malley five-stage framework for conducting scoping reviews guided our methodology. The constructs of interest for inquiry related to Canadian midwifery were the following: (1) employment models, (2) organization of practice, and (3) compensation. The study selection was an iterative search process. After duplicates were removed from both database and grey literature sources, a total of 1540 records were initially screened. After final screening was complete, a total of 111 records were included that contained content related to constructs of interest. Currently, midwifery services are publicly funded in Alberta, British Columbia, Manitoba, Ontario, Québec, Nunavut, Nova Scotia, Northwest Territories, and Saskatchewan. The four types of employment models in which midwives work are private practice, private fee for service (deemed as course of care), course of care, and salaried. Compensation varies by province depending on the model of employment. This review of publicly available literature illustrates the range of employment, practice models, and compensation of regulated midwifery across Canada, as well as the evolution of the profession in the past 27 years. This type of information is relevant to inform health workforce planning for midwifery services across the country (Canadian Task Force Classification III).