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.”
Legal Financial Aspects
The Midwifery Act is a component of the Regulated Health
Professions Act which became effective on January 1st,
1994. An individual may only practice as a midwife in
Ontario when registered with the College of Midwives
of Ontario and must have membership to the Association
of Ontario Midwives.
Midwives and midwifery care are funded through the Ministry
of Health and Long Term Care and available to all Ontario
residents with or without OHIP.
Prenatal Care
Prenatal care is an important part of promoting a healthy
pregnancy and for preparing for birth and postpartum.
Midwifery care may begin 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, any lab work, and
records from any previous pregnancies and births when
relevant. 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 detecting problems
that can arise in pregnancy. These appointments also
provide 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 30th 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 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 your baby.
Labour and Birth Care
Midwives are on-call and available 24 hours a day by
pager. During labour, a midwife will either speak to
you on the phone or assess you in person when you make
contact. Once you are in active labour, your midwife
will care for you either at home or the hospital. A
second midwife is called when labour is advanced.
In some circumstances we may use a Second Birth Attendant
if a second midwife is unavailable. These alternative
arrangements are approved by the College of Midwives
of Ontario. Clinical aspects of care during labour and
birth include monitoring labour progress, maternal vital
signs, fetal heart rate patterns and position, delivering
the baby and placenta, conducting a physical assessment
of the newborn and assessing the mother’s condition.
Midwives provide skilled clinical, physical and emotional
support during labour and birth, but 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.
If you are planning a home birth, our clinic offers
the option of a using one of our birth pools. These
can be borrowed a few weeks before your due date and
returned in the post partum. The pools also come with
plastic liners for your protection and we ask that clients
cover the $45 charge for these liners, as they are disposable.
Postpartum Care
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 mother and infant,
approximately three hours in most cases. Women who give
birth in hospital normally have the option of returning
home approximately 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. As primary health care providers, midwives
provide care for the mother and baby for six weeks postpartum.
Normally, a midwife makes at least four postpartum visits
at your home in the first two weeks following the birth.
Beyond this, we offer an optional visit at four weeks,
and a final visit at approximately six weeks postpartum.
At your final visit, we give you photocopies of relevant
parts of your file and if desired we will write a letter
to your family physician or nurse practitioner detailing
your care with us.
Philosophy of Midwifery Care in Ontario
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.
We work within a scope of practice as governed by the
College of Midwives of Ontario and collaborate and consult
with other health care providers when appropriate.
Informed choice is also 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. As described 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 medications.
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 shown 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
prenatally, 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.
If several clients are labouring and delivering concurrently,
there exists the possibility that a planned homebirth
client may have to move in to hospital to ensure that
there are two midwives in attendance at the delivery.
Our homebirth rate is approximately 30% and is a popular
option throughout the year. During this time we may
utilize the option of having second attendants. All
second attendants are certified in neonatal resuscitation
and CPR.
Student Midwives
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 hands-on practice
with registered midwives. Midwifery education is an
important part of our practice and we are affiliated
with the Ontario Midwifery Education Programme. 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.
Responsibilities as a Client
Midwifery care is based on promoting health and dealing
preventatively to avoid or minimize problems. Women
being cared for by midwives are active participants
in their own health care. We expect that clients take
a high degree of responsibility for their health and
that of their babies. Midwives are committed to providing
a supportive approach to helping clients address risk
factors such as stress, smoking and alcohol. During
pregnancy, we expect and encourage women to eat a balanced
diet, become informed, participate actively in their
prenatal care, and get adequate regular sleep and exercise.
Midwifery care is individualized according to the client’s
needs. In order for us to be most effective as caregivers,
we need clients 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,
needs, and concerns.
We respect women’s choices about whether to breastfeed
or formula feed their babies. As part of health promotion
for both women and babies we encourage clients to put
their newborns to the breast soon after birth to give
the baby valuable colostrums and to help minimize blood
loss in the mother.
We provide a lending library for clients in our clinic.
You are also welcome to use clinic resources: books,
photographs, videos and educational learning aids. Becoming
informed about issues enables clients to make informed
decisions about their choices.
Client Records and Confidentiality
We consider your midwifery records to be your property
although we are required to keep the originals on file.
We respect each client’s right to complete confidentiality,
and we do not share information from your records with
anyone outside our practice without your permission.
You have access to your records at any time. At your
6 week post partum visit we can provide you with a copy
of your records.
Contacting a Midwife with a Concern or Problem
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.
As we are a group practice, should you have any concerns
with respect to your care, please address them with
another midwife.
Our Backgrounds
The midwives in our practice are all registered with
and governed by the College of Midwives of Ontario.
We are affiliated, as a teaching practice, with the
Ontario Midwifery Education University Programme. We
bring many years of experience caring for mothers and
babies in different settings, and share a respect for
childbearing women, their families, and communities.
We would be pleased to discuss our education and experience
as midwives with you on request or you can visit our
website for our biographies.
Consultation and Transfer of Care Guidelines
Midwives work within their scope of practice as governed
by the College of Midwives of Ontario and we collaborate
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
on the time of pregnancy and the circumstance of the
situation.
The College of Midwives of Ontario’s Indications for
Mandatory Discussion, Consultation and Transfer of Care
is a guideline for midwives to identify and respond
to risk factors. Midwives work collaboratively with
partner midwives, family physicians and specialists
as needed. Most pregnancies, births and post partum
periods are normal and do not require consultation outside
midwifery of care.
Your Questions and Comments
We hope that this information has answered many of your
questions about midwifery care. Your initial information
sharing meeting with a midwife and reading this document
are part of a two way process which allows you and us
to decide if midwifery care is well suited to your needs.
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