Reprinted with permission from the Midwives of Muskoka
Ontario Midwives provide primary care for women with low risk pregnancies. Their philosophy is based on informed choice by the woman, choice of birthplace, and continuity of care.
What is midwifery?
“The practice of midwifery is the assessment and monitoring of women during pregnancy, labour, and the post-partum period and of their newborn babies, the provision of care during normal pregnancy, labour, and post-partum period, and the conducting of spontaneous normal vaginal deliveries.” (Scope of practice for midwifery as defined in the Midwifery Act 1991).
The woman is the client of the midwife and the primary decision-maker during childbearing. Midwives use the term client to refer to the woman and those family members or support people as identified by the woman.
The woman is the client of the midwife and the primary decision-maker during childbearing. Midwives use the term client to refer to the woman and those family members or support people as identified by the woman.
How is midwifery is regulated in Ontario?
Midwives in Ontario are regulated by the College of Midwives of Ontario (the College). A person cannot practice midwifery, call herself or himself a “midwife” or hold herself or himself out to be such unless they are registered with the College.
Midwives in Ontario are primary caregivers. As such, they hold full legal responsibility for their clients and are not supervised by a physician or obstetrician. Midwives in Ontario never work in only one area of client care, such as prenatal or intrapartum care. They are required to provide full service to their clients in all trimesters, throughout labour and birth and for six weeks postpartum. Under normal circumstances, a midwifery client and her newborn do not see any other health care practitioner during this time.
All midwives must attend both home and hospital births. Midwives are required to hold admitting privileges in at least one hospital and to attend a minimum number of both home and hospital births per year in order to maintain their registration.
Midwives in Ontario work as independent practitioners in group practices that are funded by the provincial Ministry of Health and Long-Term Care. They are not salaried employees of hospitals, health centres or clinics and do not work shifts. Midwifery practices provide 24 hour on-call services to their clients. This means that every midwife works on call for defined periods of time and while on call must be available 24 hours a day.
A registered midwife must follow the College’s philosophy of midwifery care, as well as a comprehensive set of guidelines, known as standards. For example, there are standards for consultation and transfer of care to physicians, place of birth, equipment and medication, record keeping, and a Code of Ethics.
Midwives in Ontario are primary caregivers. As such, they hold full legal responsibility for their clients and are not supervised by a physician or obstetrician. Midwives in Ontario never work in only one area of client care, such as prenatal or intrapartum care. They are required to provide full service to their clients in all trimesters, throughout labour and birth and for six weeks postpartum. Under normal circumstances, a midwifery client and her newborn do not see any other health care practitioner during this time.
All midwives must attend both home and hospital births. Midwives are required to hold admitting privileges in at least one hospital and to attend a minimum number of both home and hospital births per year in order to maintain their registration.
Midwives in Ontario work as independent practitioners in group practices that are funded by the provincial Ministry of Health and Long-Term Care. They are not salaried employees of hospitals, health centres or clinics and do not work shifts. Midwifery practices provide 24 hour on-call services to their clients. This means that every midwife works on call for defined periods of time and while on call must be available 24 hours a day.
A registered midwife must follow the College’s philosophy of midwifery care, as well as a comprehensive set of guidelines, known as standards. For example, there are standards for consultation and transfer of care to physicians, place of birth, equipment and medication, record keeping, and a Code of Ethics.
What can you expect from midwifery care?
(with video files from the Association of Ontario Midwives)
(with video files from the Association of Ontario Midwives)
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A midwife usually begins providing care in the first trimester of a woman’s pregnancy, and as the primary caregiver provides complete maternity care to her client, including ordering any laboratory tests, ultrasounds, etc. The midwife attends the client prenatally at the midwifery clinic, during labour and birth, and for postpartum home and clinic visits. The schedule of prenatal visits is the same as with other maternity care providers: once a month till 28 weeks, every 2 weeks until 36 weeks, then weekly until birth. Visits are 30-60 minutes in length. Postpartum home visits usually occur on days 1, 3, 5 and sometime between days 7 and 10, although this may vary according to the individual client’s needs. The mother and baby are then usually seen back in the clinic at 2, 4 and 6 weeks postpartum. Throughout the client’s care, a midwife is available on a 24-hour basis. Midwives consult with physicians if necessary and may transfer care if required. A midwife may provide supportive care to her client if care is transferred.
Midwives always carry the required equipment to attend women during the delivery of their babies in a home setting. Midwives maintain current knowledge of:
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In Ontario, the practice of midwifery is based on the principles of:
Click here to read a brief history of midwifery in Ontario |
What is the midwifery scope of practice?
(with video files from the Association of Ontario Midwives)
(with video files from the Association of Ontario Midwives)
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The scope of midwifery practice includes full care for the duration of pregnancy until six weeks postpartum for you and your baby. Should problems develop during the course of care which necessitate that care be transferred to a physician, midwives will continue to function in a supportive role until care can be transferred back. Apart from indications of mandatory consultation or transfer of care (see the following pages), you will not be expected to see a physician for any care related to your pregnancy, childbirth, postpartum, or newborn. Your family physician will resume care of you and your baby between 6 and 8 weeks postpartum.
Midwives of Muskoka follow the discussion, consultation and transfer of care protocols of the College of Midwives of Ontario. These protocols outline situations in which we would discuss with another midwife, consult with a physician, or transfer care. It is within the scope of Ontario midwives to order blood work, ultrasounds and other laboratory tests, as well as prescribe certain medications. They also have written protocols for situations that may arise in your regular care and in emergencies. These protocols outline the roles of primary and second midwife. This way, they are able to function smoothly and clearly in decision-making and action. |
They also have written protocols for situations that may arise in your regular care and in emergencies. These protocols outline the roles of primary and second midwife. This way, they are able to function smoothly and clearly in decision-making and action.
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What is the philosophy of midwifery care in Ontario?
(with video files from the Association of Ontario Midwives)
(with video files from the Association of Ontario Midwives)
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Midwifery care is based on a respect for pregnancy as a state of health and childbirth as a normal physiologic process and a profound event in a woman’s life.
Midwifery care respects the diversity of women’s needs and the variety of personal and cultural meanings that women, families and communities bring to the pregnancy, birth and early parenting experience. The maintenance and promotion of health throughout the childbearing cycle are central to midwifery care. Midwives focus on preventative care and the appropriate use of technology. Care is continuous, personalized and non-authoritarian. Midwives respond to a woman’s social, emotional, and cultural as well as physical needs. Midwives respect the woman’s right to choice of caregiver and place of birth in accordance with the Standards of Practice of the College of Midwives. Midwives attend birth in a variety of settings, including hospital and home. Midwives encourage the woman to actively participate in her care throughout pregnancy, birth and the postpartum period, and to make choices about the manner in which her care is provided. |
Midwifery care includes education and counseling, enabling a woman to make informed choices.
Midwives promote decision-making as a shared responsibility between the woman, her family (as defined by the woman) and her caregivers. The mother is recognized as the primary decision maker. Midwives regard the interests of the woman and the fetus as compatible. They focus their care on the mother to obtain the best outcomes for the woman and her newborn. Fundamental to midwifery care is the understanding that a woman's caregivers respect and support her so that she may give birth safely, with power and dignity. |
