THE MIDWIFERY MODEL OF CARE
Our Practice and Model of Care
All midwives in Ontario are registered with the College of Midwives of Ontario and are qualified primary care providers for healthy pregnancies and newborns. The scope of practice for midwives is designated in standard guidelines set out by the College. For healthy pregnancies midwives can offer prenatal testing, such as blood work, ultrasound, and other tests where indicated. We see women prenatally at our clinic and postnatally we usually visit you for the early postpartum period.
Our practice includes registered midwives and midwifery students. We provide complete care for healthy pregnant women living in Mississauga, South Etobicoke and South-East Milton. Midwives are primary caregivers for women during pregnancy, labour and the postpartum period. We also care for your newborn during the postpartum period.
Our practice follows a team-based model of care, with each client usually having a team of two or three midwives who see them alternately at each visit. One of your midwives will plan to be in attendance at your birth. Although we are strongly committed to continuity of care and try to ensure that one of your designated midwives are present at the birth, sometimes circumstances will prevent this from occurring.
We encourage women to actively participate in decision making around their pregnancy, birth and postpartum. We view our role as providing information to assist you in making these important decisions.
A midwife’s care is individualized according to your needs. In order to be effective as caregivers, it is important that you keep us well informed of problems or situations that may affect your care.
On and Off Call Time
Your midwives are on call and available 24 hours a day, seven days a week for labour and urgent concerns. Each midwife regularly takes scheduled time off call per month.
Midwives also have scheduled blocks of time off during the year (usually one month at a time) and do not book clients with due dates during their holidays. In order to cover overlap around holiday periods, some alternate arrangements may be made. You can discuss the specifics of coverage during holidays with your midwives.
As a practice, we are firmly committed to the growth of midwifery in Ontario. We feel that it is important to educate new midwives as the demand for midwifery services increases. Our practice is a teaching practice and participates in the education and supervision of midwifery students. You will meet and get to know the students in our practice during your pregnancy. Students are involved in all aspects of midwifery care and are expected to be present at prenatal and postpartum visits and at the birth. Students are always supervised and participate in your care to varying degrees depending on their level of study. For further information about student involvement please see the Student Informed Choice Package.
Regular prenatal care has been shown to improve the health of women and their babies. Each week one of your team of midwives will be in the office to provide all of the appointments for the team’s clients. This will ensure that appointments are available with some flexibility for you and that clinic is not cancelled due to births.
During your prenatal visits you will have the opportunity to learn about the changes your body goes through as the pregnancy progresses. Our care includes monitoring your blood pressure, the growth of the baby, the baby’s heart rate and position, urinalysis, assessment of your general health and that of the baby. We expect to see all clients at least once a month until the twenty-eighth week of pregnancy, every second week until the thirty-sixth week, and once a week thereafter until the baby is born.
If you developed any complications in previous pregnancies, we request that you obtain records of your birth from the midwife or physician who provided your care. If you develop any complications during your pregnancy, we will refer you to the appropriate specialist for a consultation and in some cases care will be transferred to the specialist.
Your family and friends are welcome to attend clinic with you. If you are planning to have your children at the birth, we suggest that you bring them to meet us.
When a homebirth is planned, the midwives will visit your home to become familiar with the location.
Labour and Birth
Our care in labour includes telephone support in early labour and continuous support during active labour. Two midwives will be present for the birth and immediate postpartum. Midwives monitor the progress of labour, conduct the delivery of the baby and provide immediate postpartum care for the mom and newborn, including suturing if necessary and a newborn exam. If complications develop in labour or during the birth, your midwife will consult and / or transfer care to the appropriate specialist as indicated.
We also provide help with breastfeeding, give emotional support and give information and guidance to the woman and her support people. In situations where birth plans change in labour, we continue to provide you with information about your options and give support to help you make decisions.
In most circumstances, women are encouraged to go home 3-4 hours after a hospital birth. Following home birth, midwives will remain to monitor women and their newborns for the first 3 to 4 hours. We will be out to visit you at home the following day and see you at regular visits following the birth of your baby. We continue to provide care for you and the baby until 6 weeks postpartum.
Any routine tests or treatment required by yourself or the baby in the first six weeks postpartum will be administered by your midwives. Any concerns that arise during your postnatal period should be referred to your midwife who will either address those concerns herself or refer you on to the appropriate specialist.
Choice of Birthplace
Women in our care may choose to have their babies at home or at; Trillium Health Partners Credit Valley or Mississauga Hospitals. There will be times when, based on your history or clinical condition, a hospital birth would be recommended by your midwife.
We encourage you to take the opportunity to discuss your choice of birthplace with your midwives.
In addition to taking the opportunity to discuss choice of birthplace with your midwife in a one on one setting, you can choose to attend one of the regularly scheduled information nights offered at both clinic sites to inform yourself about the option of homebirth. See the information boards posted in the clinics for scheduling information.
What happens if there are complications?
In pregnancy and labour, complications sometimes do arise. Midwives are trained to identify problems.
You and your midwife would then consult with the appropriate health care professional. In some cases your care is transferred to a physician and your midwife provides supportive care. Midwives carry monitoring and resuscitation equipment to all home births. Midwives are prepared to respond appropriately to emergency situations and update their skills on a regular basis.
Midwives and the Health Care System
Midwifery services are completely funded by the Ontario Ministry of Health and Long-Term Care for permanent residents of Ontario – with OR without OHIP. This includes both funding for the services of the midwife that you receive and funding for any indicated diagnostic tests that are ordered for you by the midwife during your pregnancy. You can have either a midwife or a doctor for your pregnancy, birth and newborn care.
Midwives, obstetricians and family physicians are all considered primary caregivers. A primary caregiver takes sole responsibility for your care. Having two caregivers is viewed as a duplication of health care services. Midwives qualify for registration either by graduating from the Ontario Midwifery Education Programme (a four-year university degree program) or the International Midwifery Pre-registration Program, offered through Ryerson University’s continuing education division. Each year approximately 40 new midwives are registered which will make midwifery care available to more women throughout Ontario. If, during midwifery care, a health concern arises beyond the scope of midwifery practice, your midwife would consult with the appropriate health care professional. Occasionally, this may result in a transfer of your care to an obstetrician, or for your baby to a pediatrician. If your care is transferred, your midwife remains with you in a supportive role.