Sudbury midwife survives brain tumour, but is now shut out of the profession

About a decade ago, Krysta Moland decided to become a midwife after giving birth to her own daughter and seeing how the profession helps empower women. 

She was loving her work with Sudbury Community Midwives, helping dozens of people every year through their pregnancies, until she got diagnosed with a congenital tumour in 2019. 

The condition has a 30 per cent mortality rate, so Moland was rushed off to Toronto for an emergency surgery that left her with an acquired brain injury.

"When your brain touches the air, you're never quite the same," she said. 

Months of rehabilitation later, Moland was ready to return to work as a midwife, but she could no longer work extended hours or night shifts on call. She now also needs a supervised return to practice due to her extended time not practicing as a midwife. 

Sudbury Community Midwives did not renew Moland's contract. 

Because they are the only employer of non-Indigenous midwives in the city, Moland says she effectively has no other potential employer to turn to. 

She is suing the Sudbury practice for wrongful termination, and says the case raises issues of human rights because the employer was not willing to accommodate her disability.

In court documents, Sudbury Community Midwives deny any wrongdoing. They argue they had no obligation to renew Moland's contract or provide alternate work arrangements, because Moland was hired to work as an independent contractor. 

Moland says she would love to reintegrate the profession. She says even if she can no longer do births and be on call, she could provide prenatal and postpartum care. 

"My midwifery could look a little different," said Moland. 

"I could take on women that need C-sections, for example. I know it's not ideal, it's not what we normally do, but it would be a way for me to work and offer pregnant people care."

Ministry pays midwives for entire course of care that includes birth

Still in court documents, Sudbury Community Midwives explain that they can only bill the Ontario Ministry of Health for a full course of care, which includes an attendance at birth. 

They say meetings to find alternate work arrangements for Moland were unsuccessful. 

"[Moland] was not able to explain how her ideas would benefit the practice or how the transfer payment agency could be billed to support any of these ideas," they write. 

They add that they invited Moland to write a proposal to obtain additional funding to cover her services but she did not take them up on the offer. 

Moland worries no midwifery practice in Ontario will be able to accommodate her disability. "No one wants to accommodate somebody they do not know, right?" she said.

Liz Darling, assistant dean of the Midwifery program at McMaster University, says the billing system with the province offers little flexibility for midwives, but that it doesn't have to be that way. 

"In BC and Alberta, midwives can bill for care directly to the Ministry rather than having to work in a practice group," she explained. "Those billings can be separated down into smaller pieces of care." 

She says it's not exactly a fee for service, but it does allow for more flexibility. 

"There is a lot of discussion within the profession here in Ontario to explore other mechanisms to pay midwives to make use of the skills we have," said Darling. 

"There are lots of gaps and needs within the system where midwives could be making a difference… but funding can be a barrier." 

She explains that if a midwifery group was to accommodate someone with a disability by letting them do the prenatal and postpartum care, they would need to find an employee that has inverse needs, and can only be on call for deliveries. 

"If we had options for people to actually be compensated for their work, midwives who aren't able to do everything could still do a lot of valuable work without it meaning that somebody else has to be doing more births."

The case involving Moland and Sudbury Community Midwives is set to head to trial.