INTRODUCTION TO MIDWIFERY CARE

138 Old Kingston Road Ajax, ON L1T 2Z9 T: 905-427-5407 F: 905-427-6090 [email protected] www.durhammidwives.com

Welcome to Midwifery Services. We are pleased that you are thinking of Midwifery Care during this very special time in your lives. The following information will help to orientate you to Midwifery in Ontario and to our practice. This is not meant to replace in-person conversations, but will, hopefully, serve as a basis for information sharing. We look forward to developing a co-operative and supportive relationship with you and your family. 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 detection 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 gynecology, family planning and child care. She may practice in hospitals, clinics, health units, domiciliary conditions, or in any other service.” MIDWIFERY FUNDING Midwifery services are funded through the Ministry of Health of Ontario. There is no direct cost for midwifery services to residents of Ontario. 2

REGULATION OF MIDWIFERY IN ONTARIO The College of Midwives of Ontario is the regulatory body for midwives. It registers midwives in Ontario and its mandate is to ensure that midwives uphold the standards set by the College. These standards include Mandatory Consultation and Transfer of Care Guidelines which indicate under what circumstances midwives should consult with a physician and/or transfer the care of a client to a physician. ORGANIZATIONS INVOLVED IN THE ONTARIO MIDWIFERY PROGRAM College of Midwives Association of Ontario Midwives

416-327-0874 www. cmo.on.ca 416-425-9974 www. aom.on.ca

Canadian Association of Midwives www.canadianmidwives.org MIDWIFERY IN ONTARIO Midwives are primary caregivers in normal births. The emphasis in midwifery care is on the promotion of normal childbirth, the prevention of health problems, and the recognition of pregnancy, birth and early parenting as normal, healthy life events. The Midwifery Model of Care in Ontario has evolved as a result of close co-operation among midwives, their clients and the public. Midwives provide care and advice to women during pregnancy, conduct deliveries on their own responsibility, and care for mothers and their newborn infants up to 6 weeks of age. 3

The principals of the Ontario Midwifery Model of Practice are: Continuity of Care: Midwifery care is available during all trimesters of pregnancy on a 24-hour on-call basis from a team of midwives. Informed Choice: Women are actively encouraged to participate in their care; midwives promote decision-making as a shared responsibility, with the woman as the primary decision-maker. Choice of Birth Location: Midwives are capable of, and willing to, provide care in either the home or hospital. SCOPE OF PRACTICE FOR MIDWIVES Women are seen by midwives for all their prenatal visits. Midwives can order laboratory and ultrasound testing and will arrange for consultation and/or transfer of care to other health care providers if necessary. Midwives provide primary care during labour and conduct normal births on their own responsibility. They examine the newborn and provide care for mothers and babies to six weeks postpartum. They can also prescribe and/or administer certain drugs during pregnancy, labour, birth, and the postpartum period. Midwives in Ontario are able to seek hospital privileges to admit and discharge their clients on their own responsibility. Midwives are not employees of the hospital. They are on-call for their clients, whether the birth is planned for home or hospital. While in hospital, midwives act as primary care providers for their clients. Midwives are responsible for the provision of care, decision-making, and the monitoring and management of labour, 4

delivery, postpartum and newborn care. CONTACTING A MIDWIFE A midwife is available 24 hours a day, 7 days a week by pager. However, if your concern does not require an immediate response, you can leave a general message at the main number and we will return your call as soon as possible. It is a good idea to have both the office and urgent number with you at all times. Urgent # Will be provide to you when you become a client Office Number: 905-427-5407 If you believe that you are in labour or you have an urgent concern and would like to contact a midwife by pager, call the paging service using the Urgent number above and ask for the midwife that is “on call” for your particular team. If you are unsure ask our receptionist or a midwife which team you are with. DO I SEE A DOCTOR DURING MY PREGNANCY AS WELL AS A MIDWIFE? No. Midwives are primary caregivers for women during pregnancy. A midwife can order any tests that you may need. However, if at any time there are any complications, it may be necessary for you to have a consultation with a physician or your care may be taken over by a physician. Also, you may need to see your family physician for any conditions which are not related to your pregnancy. Midwifery care is completed at 6 weeks postpartum. At this time you should resume care with your family physician. 5

WHAT HAPPENS IF YOU SEND ME FOR A PHYSICIAN CONSULTATION? If a consultation is necessary during pregnancy you may see an obstetrician in his/her office, if the consultation is done during labour you will see the on-call obstetrician at the hospital. The physician will give advice to you and your midwife as to what he/ she suggests for your care. In addition, we may also recommend that a pediatrician see your infant if there are concerns outside of the midwifery scope of practice. Please refer to the College of Midwives, www.cmo.on.ca for a complete list of situations where midwives are required to consult or transfer care to a physician. If you are unable to access this form please ask us for a copy. WHICH MIDWIVES AT MIDWIFERY SERVICES OF DURHAM WILL I BE WORKING WITH? In order to provide comprehensive care the midwives at Midwifery Services of Durham work in a “shared care” arrangement. We call this “team” midwifery. You will spend most of your prenatal appointments becoming familiar with the midwives and any students assigned to that team. Clients and midwives are assigned to each other largely based on geographical location. While you will get to know some midwives in the practice more than others, it is important to remember that you are receiving care from the midwifery team rather than an individual midwife. There may be situations where a midwife that you are less familiar with will become involved with your care. Considering that this group of practitioners choose to work together you will generally receive the same style of care. 6

STUDENTS In addition to the Registered Midwives, midwifery students are normally associated with our practice. These students are enrolled in the Midwifery Baccalaureate Program and spend about 50% of their education time in a Midwifery Practice. Currently in Ontario one woman is turned away from midwifery care for every woman that is booked. In order to ensure better access for women to midwifery care, it is important that we see students graduate from the program. We appreciate your cooperation in working with students. Midwifery Students are supervised by the midwives in our practice and also maintain close contact with their tutor at the university. Student midwives, who develop a relationship with you over a number of visits, accompany us and provide care appropriate to their levels, with your permission. We are committed to ensuring that the quality of care we provide is enhanced by the presence of student midwives. We support clients to be teachers of students by giving them and us feedback at all times. We encourage you to talk with us about the presence of students, and especially to raise any concerns, as midwifery education is an important part of our practice. We see pregnant women as important teachers for student midwives and we very much appreciate their support of midwifery education. WHAT ARE MY OPTIONS FOR PLACE OF BIRTH? You may choose to have your baby in your home or in the hospital. The midwife can provide you with information to make an informed decision about the appropriate place for you to give birth. Some women choose to give birth at home rather than a hospital 7

in order to ensure having a relaxed atmosphere in a secure and familiar environment. The issue of safety with homebirth is important to parents and midwives. Many studies have examined the safety of home birth, and the evidence has determined that home birth is as safe as hospital birth when women have received proper prenatal care and have been screened appropriately. Midwifery Services of Durham has privileges at Markham Stouffville Hospital and this is where our clients, who choose to deliver in hospital, go for their birth. This hospital was chosen because its philosophies are compatible with the midwifery model of care, and policies have been revised to enable us to work as primary caregivers in that institution. The midwife will support the woman’s choice of birthplace after she has carefully considered the information and recommendations. Midwives are comfortable and fully trained and equipped to provide primary care to women in both settings--home or hospital. WHAT TYPE OF EQUIPMENT DOES THE MIDWIFE HAVE FOR A HOME BIRTH? Your midwife will have with her the following emergency medical supplies: oxygen (for mother or baby), suctioning equipment, medication to help stop/prevent bleeding (for mother), and IV equipment. Midwifery Services has available a “home birth kit” for a fee of $20.00 SHOULD I GO ON A HOSPITAL TOUR? HOW DO I SIGN-UP FOR A TOUR? Yes. The hospital tour will help to familiarize you and your partner with the physical surroundings, as well as the policies, of the 8

hospital. Even if you are planning a home birth, you may find this useful. To book a tour with the hospital call: 905-472-7374. Please note: regardless of whether you plan to give birth at home or in the hospital, you must pre-register with the hospital. To preregister at the hospital they ask that you make an appointment by calling 905-472-7374. A pre-registration form and information sheet will be given to you at your first clinic visit. WHAT SHOULD I TAKE WITH ME TO THE HOSPITAL? WHAT SUPPLIES DO I NEED FOR A HOME BIRTH? The complete list of “Suggested Birth Supplies”, which lists the things that you will need to take with you to the hospital or those that you should have ready for a home birth will be given to you when you are 36 weeks. HOW LONG WILL I STAY AT THE HOSPITAL AFTER THE BABY IS BORN? Midwives at this practice and across the province have a much earlier discharge program which takes into consideration how both the woman and the baby are doing. If both you and the baby are fine, you will probably be ready to go home from the hospital within 2 - 4 hours after the birth. It has been our experience that this works quite well for families in midwifery care. After the initial euphoria from the baby’s birth passes women and their babies (partners too) are in great need of a good sleep. You are far more likely to sleep well at home in your own bed with access to your own washroom. There are other potential benefits to early discharge, such as less risk of infection, better bonding for the entire family, and reduced sibling rivalry. Should you or your baby experience any difficulties, a longer hospital stay will likely be recommended. You should 9

discuss your plans with your midwife during pregnancy and again following the birth of your baby. As well as being available to you by pager from the time you leave the hospital, we will do the first home visit the day after birth DO I NEED TO TAKE PRENATAL CLASSES? We encourage Midwifery Services of Durham clients, especially first-time parents, to attend a childbirth education program. Midwifery Education classes are offered at Midwifery Services of Durham. Please enquire at reception re available dates. There are also a variety of courses available in Durham or York region. You can find childbirth education pamphlets in our waiting room. WHAT HAPPENS IF MY MIDWIFE HAS TO GO TO A BIRTH WHEN I HAVE A PRENATAL APPOINTMENT? This is an unfortunate situation that cannot always be avoided. However, it is surprisingly uncommon, and we ask you to be understanding (of course, it could be you one day!). If this happens, our office will attempt to contact you, and it may be possible to see another midwife in our practice. However, we ask you to take the responsibility to ensure that your midwife is available by calling in to the main number or checking with the midwife’s voicemail just prior to your visit. WHAT SHOULD I DO IF I CAN’T MAKE AN APPOINTMENT? We would appreciate as much notice as possible when cancelling an appointment. If you are in your last month of pregnancy, it is important that you be seen on a weekly basis; please try to keep your scheduled appointments, and, for your convenience, we recommend from 36 weeks onward, that you book at least 2 prenatal appointments ahead. 10

WHAT HAPPENS IF YOU ARE BUSY AT ANOTHER BIRTH OR WHEN YOU GO ON VACATION? In most cases, two midwives will attend to you during your labour/delivery. However, in some instances, we may need to call on a midwife from another team. A midwife from your team will be your primary midwife and the backup midwife may be called from another team. Please be aware that, very rarely, your midwives may find themselves in a situation where there are several labours happening simultaneously. For reasons of safety two midwives are required to be present at each birth. If necessary, you may be asked to move from a home birth to a hospital setting as circumstances dictate. This is a very uncommon occurrence, and should it happen, your understanding would be appreciated. WHAT SHOULD I DO IF I HAVE A PROBLEM OR A CONCERN REGARDING MY CARE? Please feel free to speak directly with your midwife about any problems or concerns that you might have regarding your care. We strive for open communication with our clients and rely on you to give us feedback. If you are not comfortable with this, you may contact one of the other midwives and your concern will be addressed at a practice meeting of the midwives in our office. DO YOU HAVE A LENDING LIBRARY FOR BOOKS OR VIDEOS? Yes, our office has a wide variety of books and videos that may be borrowed by our clients. We request that you leave a $20.00 cash deposit when you come into care which will be returned at the end of your care when all books and videos which you may have borrowed have been returned. Some of our books have been donated by previous clients who have purchased books on 11

their own; we would certainly welcome any contributions that you might be able to offer, when the time comes. PRENATAL CARE Prenatal care is an important part of preparing for birth and offers you the possibility to learn about the changes your body goes through as pregnancy advances. Once you decide to participate in midwifery care, we schedule a first clinical visit which includes a health history taking and a general physical assessment. You will be shown how to check your urine with a urine analysis “stick” and monitor your weight on our office scales. Ongoing visits include the monitoring of blood pressure, fetal growth, heart rate and fetal position, urinalysis and the general health of mother and baby. Midwives can order blood work and ultrasounds when indicated and can prescribe a limited number of medications. We expect to see pregnant women approximately once a month until 7 months, every second week until the last month, and then weekly until your birth. To ensure adequate time for discussion and teaching we would like you to have your urine and weight done prior to your appointment time. Our appointments sometimes run late because of demanding situations; arriving on time can avoid any unnecessary delays or the cancellation of your appointment. The schedule of appointments can be flexible and adjusted in terms of frequency according to your needs. Most appointments are 30 minutes in length to allow for comprehensive clinical examinations and time in a supportive environment for listening, education and counselling as needed. This is an important role for Ontario midwives as it enables women to make informed choices regarding their care. The relationship between the midwife and her client is co-operative rather than authoritarian. 12

Midwives are responsible for the care provided and recognize the woman as the central decision maker. We may request the records of your care from previous pregnancies and births. You are welcome to bring anyone you wish to your appointments. LABOUR AND BIRTH During early labour a midwife and student midwife will be in contact with you over the phone and will attend you once active labour is established. The clinical aspects of labour care include: monitoring labour progress, maternal vital signs, fetal heart rate and position, providing perineal support, delivering the baby and afterbirth (or placenta), assessing the well-being of mother and baby. A second midwife or final year student is called when labour is advanced. (In exceptional circumstances the second attendant may be a nurse or a person with the proper credentials who has been approved by the College of Midwives.) Midwives provide skilled physical and emotional support during labour but the most important support is that of your partner, family and/or friends. You are welcome to have whomever you wish present at your birth. After the birth we support keeping you and your baby together in a quiet and respectful environment with the people of your choice supporting you. We will help you to breastfeed within the first hour and we will continue to provide both clinical monitoring and emotional support while giving information and guidance as needed.

13

POSTNATAL CARE After the birth, whether in a home or hospital setting, we remain until we are sure that all is well with both mother and baby, approximately three hours in most cases. Women who give birth in hospital will normally be expected to return home about three hours after the birth. A midwife and student midwife will visit you in your home during the first day to answer questions, help with breastfeeding and assess you and the baby. We will make postpartum visits to your home, based on your needs, within the first 7 days following the birth. You and your baby will then come to the clinic when the baby is around 2, 4 and 6 weeks of age. More frequent visits can be arranged if needed. We assume responsibility for the care of both you and your baby and will ask you to see your family physician after our care ends at six weeks. WHAT IS MY RESPONSIBILITY AS A CLIENT? Midwifery care is based on promoting health and trying to deal preventatively with problems. We see women and their families as active participants in their midwifery care and we expect that you take a high degree of responsibility for the health of yourself and your baby. Mothers should eat a balanced diet, participate actively in prenatal care and get adequate, regular sleep and exercise. If you have difficulty in your life with risk factors such as obesity, smoking or alcohol intake and/or have fears and concerns about labour, breastfeeding and early parenting, you should know that we are committed to providing a supportive approach to helping you work with these. We ask that you take the lead in talking about your experience and needs. You are welcome to 14

come in early for your scheduled appointments to use our resources: books, photographs, videos and educational learning aids. Midwifery care is individualized according to the client’s need and in order to be effective as caregivers, we need parents to keep us well-informed of problems or situations which may affect care. HOW CAN I SEE MY RECORDS? All records that are kept by us during your care are available for you to view at anytime. Please feel free to ask your midwife any questions that you have regarding your records. At 36 weeks, a complete set of records will be transferred into a binder, which you will be given, and should be kept by you until after the birth of the baby at which time they are returned to the clinic. It is important that you remember to bring the binder with you to your visits. YOUR QUESTIONS AND COMMENTS We hope that this information has helped you to think of questions and comments. Your initial interview with us 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. Before you make a decision to work with us, please make sure that you understand and feel comfortable with the care we have described.

15