For our special 50th anniversary issue, Canada’s brightest, boldest, and most rebellious thinkers, doers, and creators share their best big ideas. Through ideas macro and micro, radical and everyday, we present 50 essays, think pieces, and calls to action. Picture: plans for sustainable food systems, radical legislation, revolutionary health care, a greener planet, Indigenous self-government, vibrant cities, safe spaces, peaceful collaboration, and more—we encouraged our writers to dream big, to hope, and to courageously share their ideas and wish lists for our collective better future. Here’s to another 50 years!

I’ve read a lot of hospital memoirs lately: anecdotes featuring shit and piss—stories that detail the bloody mess of having a body. I can see myself in them. It’s soothing to witness your own physical pain and trauma (and moments of hilarious bodily fluid explosions) mirrored back. As a disabled woman, I ache for community that normalizes my “abnormal” body.

At the same time, I often cringe. It’s a complicated cringe. I’m not grossed out. It’s more a cringe of fear. When I read about other sick and disabled people who stipulate that their bodies be respected and their truths be heard, I feel admiration, respect, and a certain kind of panic. It’s a (perhaps irrational)worry that good health care provision is a finite resource that will be taxed by too many of us asking, asking, asking.

Over the years my strained relationship with the Canadian health care complex has achieved a fine balance: I don’t ask for a lot but I firmly demand what I need. My strategy for self-advocacy when navigating the doctor’s office: wear a nice blouse. Speak calmly and know how to describe your pain. Don’t complain when they touch your body without asking first. My strategy is significantly bolstered by my white skin. My tactics are assisted by my expensive clothes. It matters that I am a cisgender woman. All the ways that I pass make it easier.

In Canada we are lucky to have access to health care and I am grateful. But still I long for more—for better. I dream of a future where our Canadian health care system is radically restructured. I want for health care to be truly accessible. I imagine a world where patients are recognized and trusted as holding expert knowledge concerning their own bodies.

In this dream world hospitals would be better funded. In this dream world health care practitioners would work less and have more space and time for each patient. Medical school would not only teach students how to care for the sick but also learn empathy. The medical understanding of the human experience would be intersectional. Imagine a world where your health care practitioner could acknowledge the physical implications of living in a white supremacist patriarchy, as well as understand the functionality of your liver. Imagine a tiered system where hospitals involved social service workers, counsellors, and peer support workers as well as nurses and doctors.

Imagine a world where disability or physical difference was not a problem to be solved, rectified, and rendered normal, but where we instead honoured our individual resilience. I want for a doctor’s office that can offer me relief, but still see me as strong. I want to take a page from all of those memoirs and confidently ask, ask, and ask. I want for my body to leak, sway, and take up space, and to demand no less for all of that.

Safe, affordable midwives are in demand, but a lack of education and funding forces healthy mothers into hospitals. Creative Commons Photo by Dave Haygarth.

It wasn’t until the early 1900s that it became “normal” to have a baby under the watch of an obstetrician in a hospital. But over the last few decades, childbirth has become an increasingly complicated, medicalized affair, with more inductions, surgeries, and drugs than ever before. The advancements have saved many otherwise dangerous deliveries, but it can also traumatize healthy mothers who would otherwise be fine on their own. Cesarean sections are increasingly common, for instance: Canada’s current C-section rate is 28 percent. The World Health Organization says it should be closer to 15.

Modern hospital-based childbirth, says Tonia Occhionero, Executive Director of the Canadian Association of Midwives, could result in a “cascade of interventions.” Sometimes there’s a temptation to use every tool available, even if that’s not always the best option. An unnecessary induction of labour, for example, can produce a snowball effect, with medical interventions accumulating, quickly complicating low-risk births into higher-risk ones.

According to the Canadian Association of Midwives, 70 to 80 percent of women could deliver on their own without complications and would therefore benefit from midwife supervised delivery at home, in a special birthing centre (only in Quebec) or even at a hospital. But health-care providers have been slow on the uptake.

“There are a lot of misconceptions about what a midwife is,” says Occhionero. “But how can we expect the general public to understand when midwifery still manages to be left out of Health Canada’s literature?”

But even without promotion of midwifery, more women are rejecting the assembly-line hospital birth—demand for midwives far outruns supply. There are only 850 midwives across Canada, 435 of whom are in Ontario, the first province where the profession was regulated in 1994. Ten percent of Ontario births are attended by midwife—but 40 percent of women who request a midwife cannot get one. With only six university programs offering certification, the shortage persists.

Occhionero says that situation will continue this way until schools add midwife training, which despite its earth-mother reputation is a highly professionalized four-year baccalaureate degree.

“It’s very regulated,” says Occhionero. “Not just anybody goes around catching babies.”