- What is a Midwife?
- Standards and Scope of Midwifery Care
- Informed Decision Making
- Prenatal Care
- Labour and Birth Care
- Postpartum Care
- Choice of Birth Place and Homebirth
- Our Catchment Area
- Access to Client Records and Confindentiality
- Teaching Practice
- Temporary Alternate Practice Arrangements
- French Language Resources
- Contacting a Midwife
The ideal relationship between a midwife and a woman and family she cares for is a cooperative one, which recognizes the woman as the primary decision-maker. A client is encouraged to actively participate in her care throughout pregnancy, birth and postpartum, and make choices about the manner in which care is provided. The midwife’s role is to assist the woman to make informed decisions regarding her care. The information in this informed choice document assists in forming that kind of cooperative relationship.
Midwifery care is based on promoting health and dealing preventatively to avoid or minimize problems. Regular prenatal care is essential. We expect clients to do their best to maintain good health during their pregnancies by eating a balanced diet, getting adequate rest and exercise, and seeking knowledge and skills to help prepare for labour, birth and postpartum.
You are welcomed to use the clinic lending library and other resources: books, photographs, videos, community resources binder and educational learning aids. The clinic offers prenatal classes and infant massage workshops and pregnancy massage workshops. Becoming informed about issues enables clients to make their expectations known and to keep us well informed of any problems, concerns or situations that may affect care. We ask that you take the lead in talking about your experiences, concerns and needs.
What is a Midwife
The World Health Organization defines a midwife in this way:
“She must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum periods, to conduct deliveries on her own responsibility and to care for the newborn infant. This care includes preventative measures, the detections of abnormal conditions in mother and child, the procurement of medical assistance and the execution of emergency measures in the absence of medical help. She has an important task in health counselling and education, not only for the patients, but also within the family and community. The work should involve antenatal education and preparation for parenthood, and extends to certain areas of gynaecology, family planning and child care. She may practice in hospitals, clinics, health units, domiciliary conditions, or in any other service.”
The Midwifery Act is a component of the Regulated Health Professions Act, which was proclaimed on January 1st, 1994. A person may only practice as a midwife in Ontario if registered with the College of Midwives of Ontario. Midwifery care is publicly funded through the Ontario Ministry of Health, and there is no additional cost for women.
Standards and Scope of Midwifery Care
The model of midwifery care in Ontario reflects the tenets of continuity of care, informed choice and choice of birth place. Within the midwife’s scope of practice and according to the standards of practice set by the College of Midwives of Ontario, the midwife follows the woman throughout the full course of care from pregnancy to six weeks postpartum, and attends the birth in the setting chosen by the woman. Midwives are primary caregivers, responsible for their own clients and provide comprehensive, individualized care to women anticipating normal, low-risk pregnancy and birth. Choosing midwifery care means you are choosing care that focuses on pregnancy, childbirth and postpartum as a normal, healthy process. Midwifery services are an alternative to, not in addition to medical and nursing care, for normal pregnancy and birth, and postpartum.
Midwives work within their scope of practice as governed by the College of Midwives of Ontario and collaborates and consult with other health care providers when appropriate. Most pregnancies, births and postpartum periods are normal and do not require consultation outside of midwifery care. However, if a complication or situation occurs outside the midwifery scope of practice, midwives work in a team with the medical professionals and are responsible for referring and transferring clients to appropriate specialists. If it became necessary to transfer primary care of a client to a physician, the midwife may continue to provide supportive care within the scope of practice, in collaboration with the physician and client depending the time of pregnancy and the circumstance of the situation.
Informed Decision Making
Informed choice is an underlying principle of midwifery care in Ontario. Women have the right to receive information and be involved in the decision making process throughout their midwifery care. In the college of Midwives of Ontario’s Philosophy of Midwifery Care in Ontario document, the childbearing woman is recognized as the primary decision maker. The interactive process of informed choice involves the promotion of shared responsibility between the midwife and her client. Midwives encourage and give guidance to clients wishing to seek out resources to assist them in the decision making process. It is the responsibility of the midwife to facilitate the ongoing exchange of current knowledge in a non-authoritarian and co-operative manner, including sharing what is known and unknown about procedures, tests and medication.”
This quote is taken from the College of Midwives of Ontario Informed Choice Standard document.
Prenatal care is an important part of promoting a healthy pregnancy and for preparing for birth and postpartum. Midwifery care begins with an information-sharing meeting between a midwife and the woman and whomever she chooses to bring to this meeting. Partners, and whomever else the woman chooses, are especially encouraged to attend this first meeting. At this initial visit time is spent getting to know the woman, her partner, their plans and concerns, and answering questions about midwifery care.
Once a woman decides to become a midwifery client, prenatal care is provided in the clinic. The first visit includes a health history and a general physical assessment. If you have been seen by another caregiver before you came into midwifery care, the midwife will request those prenatal records and records from any previous pregnancies and births. Ongoing prenatal visits include monitoring blood pressure, the baby’s growth and heart rate and the general health of mother and baby. Midwives may order routine lab work, ultrasounds, and genetic screening and counselling. They can prescribe a limited number of medications.
Prenatal care plays an important role in preventing and detection problems that can arise in pregnancy. It provides you with opportunities to learn about the changes your body goes through as the pregnancy advances. The midwife can offer counselling and advice on nutrition, exercise, and social and emotional aspects of pregnancy.
During pregnancy, appointments are approximately once a month until the 28th week of pregnancy, approximately every second week until the 36th week, then once a week until birth. This schedule of appointments is flexible and may be adjusted according to your needs. Most appointments are 30 to 45 minutes in length. Other family members or friends are welcome to accompany you during visits. Occasionally appointments may be rescheduled because your midwife is attending a labour and birth, just as the appointments of other clients may have to be rebooked when you are having you baby. All clients will also have an opportunity to meet our nurse practitioner and lactation consultant during prenatal care. There is also the opportunity to meet with the other members of the team as needed for massages, and traditional therapies. Due to a lack of funding the traditional services are not covered through the clinic at this time. We hope to be able to offer coverage once funding has been received.
If you are planning a home birth your primary midwife will visit your home towards the end of your pregnancy. It will be to become familiar with the location, to meet others who are expected to be present at the labour or birth, and to answer any questions.
Labour and Birth Care
Midwives provide skilled clinical, physical and emotional support during labour and birth. The most important emotional support is that provided by your partner, family and/or friends. You are welcome to have whomever you wish present at your birth. It is very important during prenatal appointments that your midwives meet the person (or persons) whom you plan to have with you during your labour and birth.
Midwives are on-call and available 24 hours a day by pager. Once you are in active labour, your midwife may care for you at home or in hospital. During labour and birth, midwifery care includes the assessment of progress, monitoring the mother’s vital signs and the baby’s heart rate and position, and assisting with the birth of the baby and placenta. A second midwife, or second birth attendant, attends the birth for the second stage of labour, birth and immediate postpartum.
In the immediate hours after your birth, whether in a hospital or home setting, we remain with you until we are sure that all is well with birth mother and infant, approximately three hours in most cases. Women who give birth in hospital normally have the option of returning home about three hours after birth, providing both mother and baby are well.
In those first few hours following the birth, it is ideal to keep you and your baby together in a quiet environment with the people of your choice supporting you. If you are planning on breastfeeding, we will help you initiate feeding usually within the first hour after birth. The midwife closely monitors the mother’s and baby’s condition and conducts a physical examination of the newborn.
Midwives provide care for the mother and baby for six weeks postpartum. Normally, a midwife makes at least three postpartum visits in your home in the first seven days following the birth. Then postpartum visits are scheduled in the clinic around 2 weeks, 4 weeks and 6 weeks postpartum. At your final visit, we give you photocopies of relevant parts of your file for you to bring to your family physician or nurse practitioner.
Choice of Birth Place and Homebirth
Choice of birth place is a fundamental component of midwifery practice. Midwives provide midwifery care for births planned for home and hospital. There are distinct risks and benefits to giving birth in any location. Choosing to give birth, either at home or in hospital, means the acceptance of certain risks. It is the responsibility of the client and her partner to become as informed as possible, to weigh benefits and risks, and to make decisions appropriate for themselves. We encourage you to discuss these issues with your midwife. Recent studies published have given the safety of home and hospital to be equal when skilled care providers are present, ie. Midwives.
Adequate prenatal care and careful monitoring in labour by a known caregiver are important factors in preventing, detecting and managing complications. Although many complications can be detected prenataly, difficulties can arise during labour and birth. Most of these complications are not life-threatening and can be dealt with at home, or mother and baby can be safely transported to hospital. There are rare circumstances when use of the technology available only in hospital may be essential for the safety of mother and/or baby.
In accordance with the international midwifery and medical research literature, midwives support the choice of planned home birth as a safe option for healthy, low risk women. Provided your pregnancy remains low-risk, you may choose to give birth either in hospital or at home in the primary catchment area.
Our Catchment Area
Our practice provides midwifery services throughout the region of Sudbury. Women who live in our primary catchment area (within 25 minutes driving distance from the hospital) have the option of home or hospital birth. Hôpital regional de Sudbury Regional Hospital is a modified Level 3 hospital, and can provide emergency Cesarean sections with a thirty-minute lead-time. Therefore, the catchment area for homebirths was based on this and ambulance transport time. If you would like an out-of-hospital birth, but live more than 25 minutes from the hospital, you will need to arrange to give birth at an alternate location – that is, within 25 minutes of the hospital.
Access to Client Records and Confidentiality
We consider the information in your midwifery records to be your property, although we are required to keep the original records on file. You may access your records at any time. If you wish, we can provide you with a copy of your records.
We respect each client’s right to confidentiality. We do not share information from your records with anyone outside our practice without your permission. The Ontario Ministry of Health requires certain clinical data for invoicing and for statistics. The Association of Ontario Midwives compiles anonymous midwifery data for analysis.
A four-year baccalaureate Midwifery Education Programme (MEP) began in September 1993 at Laurentian, McMaster and Ryerson Polytechnic universities. A vital part of student midwives’ education is preceptoring with registered midwives. Midwifery education is an important part of our practice. Our midwifery practice is affiliated with the Ontario Midwifery Education Programme, especially with the MEP at Laurentian University.
Student midwives accompany midwives and, with clients’ permission, provide care appropriate to their levels of education. The student midwife develops a relationship with a client over a number of visits. Clients are encouraged to talk with us about the involvement of students and to raise any concerns. We see clients as valuable teachers for student midwives, and we very much appreciate clients’ support of their education. We are committed to ensuring that the quality of care we provide is enhanced by the presence of student midwives.
Temporary Alternate Practice Arrangements
The College of Midwives of Ontario states in its Temporary Alternate Practice Arrangements within the Model of Midwifery Practice document:
“In order to provide continuity of care and choice of birth place in a midwifery practice, primary care is normally shared by a small group of midwives with two of these midwives present at each birth. The College of Midwives recognizes that alternate practice arrangements may be needed in some circumstances where this is not possible.”
While Midwives of Sudbury / Sages-femmes de Sudbury is growing, the practice has approval from the College of Midwives of Ontario to use this arrangement. Until the practice can regularly provide two midwives at each birth, a qualified Second Birth Attendant may backup a midwife at home and hospital births. At hospital births, a Labour & Delivery nurse attends births with the primary midwife if a second midwife is unavailable. A Second Birth Attendant may be present in hospital as a helper during labour and the first few hours following birth.
In the unlikely situation where there were three simultaneous births, the obstetrician on-call at the hospital would be called to attend one of the births.
French Language Resources
A goal of this practice is to provide midwifery services in both official languages. When possible we will match francophone midwives, and student midwives, with clients who prefer that care be provided in the French language. Much of our written material for clients is available in French.
Contacting a Midwife
A midwife is available 24 hours a day by pager to help clients with a problem or concern which cannot wait until their next clinic appointment. Clients are given the telephone number of the pager with verbal and written instructions on using the pager service. Other messages or non-urgent concerns can be phoned into the clinic and these messages will be responded to as soon as possible. Clinic messages are checked several times a day.