Midwife Manavi Handa (left) Nurse Sideeka Narayan (right) Photo: Courtesy of the Association of Ontario Midwivesby Amber Lepage-Monette, Association of Ontario Midwives

Collaboration between Ontario’s Community Health Centres (CHCs) and Midwives can deliver powerful positive change. A case in point:  Midwife Mondays, a CHC- Midwife partnership operating in Toronto’s west end designed to support pregnant women without status.

The model has been highly beneficial and can be easily adapted in other settings. Organizers are hoping to conduct research and disseminate findings on how this can move forward.

It all began in 2012 shortly after the establishment of the Non-Insured Walk-in Clinic (NIWIC) a collaboration of seven Community Health Centres (Access Alliance MHCS, Unison HCS, LAMP CHC, Black Creek CHC, Davenport-Perth NCHC, Stonegate CHC and Rexdale CHC.) This nurse-led clinic was launched in March 2012 at Access Point on Jane to provide episodic care at no cost to non-status/non-insured individuals who do not have a Primary Care Provider (MD or NP) and live in the city of Toronto.

Not long after the clinic’s opening at Access Point on Jane, it quickly became clear to nurse clinical coordinator Sideeka Narayan there was another group of people whose needs the clinic still could not meet – pregnant women without status.

“We were not set up to provide ongoing, routine prenatal care,” explains Narayan. Understanding the critical importance of prenatal care, particularly to this vulnerable population, Narayan embarked on finding a solution.

Fortunately, she knew that accessing support from midwives would be a good place to start.  In Ontario, a midwife is a registered health care professional who provides primary care to clients throughout low-risk pregnancy, labour and birth. Midwives also provide care to both mother and baby for six weeks postpartum. Midwives attend clients giving birth at home, in hospital and, in Ottawa and Toronto, in birth centres.

Through her work at Access Alliance Narayan Narayan had developed a close working relationship with midwife Manavi Handa of West End Midwives.  Together they set out developing a prenatal care solution for pregnant women without status.

In the summer of 2013, Handa began volunteering every Monday at the clinic offering prenatal assessments, but found the enormity of the situation required a more coordinated effort.

“I soon realized I wasn’t able to be the only midwife volunteer and thought this would be a great opportunity for other midwives to build similar CHC relationships,” she says.

Handa approached seven midwifery clinics that service the west end of Toronto and quickly had everyone on board – practices have agreed, when possible, to prioritize the clients referred from the New Immigrant Women’s Clinic.

She also reached out to Toronto midwives looking for others to rotate the “Midwife Monday” volunteer role. Handa was overwhelmed by the response and was able to recruit more than a dozen midwives.  Each takes turns volunteering  in the clinic on Monday nights.

The midwives perform an initial prenatal assessment and also gather a brief health and obstetrical history to determine if clients are high or low risk. Those who are low risk are referred to one of the seven midwifery practices that try to prioritize these clients. Those at high risk are referred to an obstetrician.

Since “Midwife Mondays” began in 2013, the midwives have seen more than 30 clients – 75% of which have gone into midwifery care at one of the partnering midwifery practices.

“If this community clinic didn’t exist, where would these women be going?” asks Narayan. “We’re providing care that wasn’t there before, so we’re improving birth outcomes.”

The interprofessional work at the clinic also ensures clients receive optimal care. When clients require tests for conditions outside of maternity care, nurses can order tests and requisition results.   

This kind of valuable work, and that provided by the midwives volunteering with the NIWIC, is possible thanks to midwives’ dedication Handa says.

“What has made this so successful is the number of midwives who have volunteered,” she says.

The Statistics

(from Manavi Handa, Assistant Professor - Midwifery Education Program, Ryerson University)

  • There are a growing number of non-status immigrants in Canada
  • First/permanent landing place are usually large urban centers: Toronto, Montreal and Vancouver
  • The magnitude of the problem: 500, 000 - 1 million Nationally, ~20,000 - 200,000 in Toronto
  • Many new immigrants are women of childbearing age
  • Toronto uninsured clinics report 20% of clients accessing services are women needing antenatal care


  • Most cost-effective way to improve outcomes for all pregnant women and infants
  • No prenatal care: 4x more likely to have low birth weight babies, 7x more likely to be preterm
  • Indisputable association between prenatal care and birth outcome
  • Compelling “bottom-line” argument: every $1 spent on prenatal care saves $2-3, $2400-$3200 per person (U.S. Data)
  • long term consequences for children
  • children of uninsured women tend to be uninsured (even when eligible)
  • parental fears/misunderstanding of policy