There are currently over 500 midwives in Ontario! In 1994, Ontario became the first province in Canada to regulate midwifery. Since that time, midwives have attended more than 100,000 births in Ontario. Midwifery services are funded through the Ministry of Health of Ontario. There is no cost for midwifery services provided by your midwife in Ontario even if you do not have OHIP coverage. Midwives are primary health care providers that care for low risk women and babies during pregnancy, labour and birth, and the post-partum period. We provide prenatal care on the same schedule as a family doctor or obstetrician, conduct normal vaginal births, and provide care to mothers and babies during the first 6 weeks following delivery. Midwives are a choice of maternity care provider, not an additional service to what you would receive from a physician. If a complication arises at any time during your care, your midwife will make timely arrangements for you to be seen by a doctor or another care provider as appropriate. The College of Midwives of Ontario has produced a document entitled, “Indications for Mandatory Discussions, Consultations, and Tranfers of Care”, that describes situations when midwives are expected to consult a physician. The College of Midwives of Ontario (CMO) regulates the practice of midwifery in Ontario. They determine our scope of practice and our standards of care. All midwives in Ontario are registered with the CMO, and are required to provide maternity care which meets these standards. The main concepts of midwifery care as determined by the CMO are providing informed choice, continuity of care, and choice of birthplace. Please read on for a more detailed explanation of these standards.
Continuity of Care: Midwifery care is provided to clients from a small team of midwives that are known to the woman. For urgent concerns, midwifery clients have access to a 24 hours-a-day, 7 days-a-week paging service that will connect them to a known midwife. At Born Midwives, we work in a shared care model. This means that your assigned midwife will work on a team with another midwife(ves). You will meet the other midwife(ives) on your team on a frequent basis so that they know you, and you know them well. When your assigned midwife is off-call (all midwives take regular time off-call to stay well rested and energized so they can give you the best support possible), another midwife on your team will be on-call for you. This way you will likely have a midwife at your delivery that is very familiar to you. Sometimes we experience high volumes of deliveries or very long births. In order to maintain safety for you and your midwives, it may become necessary for a midwife from another team to provide care to you while a midwife from your team is resting. This rarely happens, but is important to be aware of. You will have the opportunity to meet the midwives on another team if you wish.
Informed Choice: Women in midwifery care are actively encouraged to participate in their care; midwives promote decision-making as a shared responsibility, with the woman as the primary decision-maker. This means that every test or option available in pregnancy, labour, and to the newborn is discussed, including risks, benefits, and alternative options. Once you are armed with the information, you will be able to make the decision that is right for you.
Choice of Birth Place: Midwives support choice of birthplace and are the only care providers who provide the option of home birth. We have privileges to deliver out of Cambridge Memorial Hospital which is where about 80% of our deliveries occur. Your midwife will discuss the risks and benefits of both of these options so that you can decide what is best for you. Midwives carry with them at all times the same equipment you would find in a hospital to conduct a normal vaginal delivery. We also carry emergency equipment like resuscitation equipment for newborns, medications to stop bleeding, IV supplies etc.
Frequently Asked Questions
Q. What is a Midwife?
A. Midwives are primary healthcare providers who provide prenatal, labour, birth, and post-partum care to healthy women and their newborns. Midwives are responsible for all aspects of prenatal care, provide clinical monitoring and support during labour, and take care of moms and newborns for up to 6 weeks following birth. The profession of midwifery is funded by the Ministry of Health and Long-term Care, and regulated by the College of Midwives of Ontario.
Q . Do I need to pay for a midwifery services?
A. No. Midwifery services are covered through the special branch of the Ministry of Health and Long Term Care, known as the Ontario Midwifery Program. Even women without OHIP coverage, have their midwifery services paid for through this program (this does not include fees for lab testing, ultrasound, consultants, or hospital stays).
Q. Do I have to have my baby at home if I have a midwife?
A. No. Midwives offer you the choice of whether you would like to deliver your baby at home or in the hospital. In Cambridge, about 20% of babies delivered by a midwife, are born at home, and 80% are born at Cambridge Memorial Hospital. Homebirths are only recommended for low-risk pregnancies. Please see our choice of birthplace page for more information on these options.
Q. Does having a midwife mean I can't have an epidural in labour?
A. No. Midwives offer a full range of pain relief options in the hospital setting. However, currently Cambridge Memorial Hospital restricts midwives from maintaining primary care when their clients require epidural analgesia. This does not mean you lose your midwife/midwifery services. It simply means that the on-call obstetrician is responsible for you care once the epidural is given, including performing the delivery of your baby. During this process your midwife will stay involved in your care in a supportive roll. This means that once you are comfortable, and no longer need her support, she may leave the hospital and return later on when you begin the pushing phase of labour. Your midwife will continue to look after you and your baby following the birth on the normal midwifery care schedule. The midwifery group at Cambridge Memorial Hospital is actively pursuing the right to maintain the care of our clients who require epidural anesthesia.
Q. Do I need to see a doctor and a midwife during my pregnancy?
A. No. Midwives provide complete pregnancy, labour, birth, and postpartum care until six weeks after your baby is born for low-risk women and healthy babies. This includes ordering the necessary tests and ultrasounds. If a complications or concern presents during your pregnancy, labour, post-partum, or with your infant, your midwife will refer you to the most appropriate physician. Your midwife will recommend that you continue to visit your family doctor for non-pregnancy related concerns.
Q. How often do I see my midwife?
A. Born Midwives will generally see women for their first prenatal appointment sometime between 7 and 12 weeks of pregnancy. Following your first appointment, you will be seen about every 4 weeks until you are 28 weeks, then every 2 weeks until you are 36 weeks, then weekly until you have your baby. Once your baby is born, we will see you every other day at home or in hospital for the first 7 to 10 days. Then we will see you in our clinic environment at 2, 4, and 6 weeks post-partum. Following your last visit, we will recommend that you schedule a well-baby check-up with your family physician. Clinic appointments generally last about 30-45 minutes.
Q. How do I sign-up for midwifery care?
A. To sign up with Born Midwives, please click here or visit our registration page and fill out our online secure registration form. One of our midwives or support staff will call you within 5 business days to schedule your first appointment. You may also be referred through your family physician’s or nurse practitioner’s office.
Q. How do I know if midwifery care is right for me?
A. Midwives provide maternity care based on the ideals of: providing continuity of care- meaning you’ll get to develop a relationship with your midwife and know who delivers your baby, informed choice- meaning that you are the primary decision maker in your care and your midwife will provide you with the information about all of the choices you will make throughout your care, and choice of birthplace- meaning you may deliver your baby at home or in the hospital. If these are things you would like to incorporate into your care, and you are a healthy pregnant woman, midwifery care is likely for you!
Q. Am I too old or too young to have a midwife?
A. Midwives may see clients of any age. Certain age categories are risk factors for complications in pregnancy. Due to these risk factors, your midwife may recommend additional testing, or request that you see a physician for a consultation. A consultation means that you will visit a physician at least one time during your care. The physician will review your health and may make recommendations about how to care for you best in pregnancy. Most often, midwives will continue to be your main care provider.
Q. Can I have a midwife if I’ve had a previous caesarean section?
A. Most often the answer is yes. Your midwife will take an in-depth history of your previous deliveries(y) and, with your permission, review the records from your caesarean section. She will then discuss your options with you. Please click here to view our package of information on birth after caesarean section.
Q. What tests can a midwife order?
A. Midwives can order the standard blood work required in pregnancy including tests to look at the health of your blood stream, screen you for specific diseases, and determine your risk of having a baby with specific chromosomal or developmental concerns. They are also able to order obstetrical ultrasounds.
Q. What training do midwives have?
A. Midwives who are new to the country but who have trained as midwives elsewhere in the world, complete the International Midwifery Pre-registration Program (IMPP) through Ryerson University. This program ensures these midwives are educated about the standards of midwifery care in Canada through both classroom teaching and working with a registered midwife in Ontario. Please click here for more information on the IMPP program. Midwives who have started their careers in Ontario go through a 4 year (9 semester) midwifery education program (MEP) to obtain a Baccalaureate Degree of Health Sciences in Midwifery offered at Laurentian, McMaster, and Ryerson University. Please click here for more information on the MEP.
Q. What should I do if I have a concern about my care?
A. At Born Midwives we strive to provide you with excellent care throughout your pregnancy, labour, and post-partum. If you are not happy with the care you are receiving we strongly encourage you to bring these concerns to your midwife. If this is not possible, we request that you discuss your concerns with your back-up midwife or our administrator. If you have serious concerns about a midwife’s clinical care and your concerns are not being addressed, you can make an official complaint with the College of Midwives (click here for this information). Complaints are taken extremely seriously and may result in disciplinary action.
Q. Am I guaranteed to get a midwife on my team for my delivery?
A. Our goal is to provide continuity of care which includes having someone you know present throughout your labour and delivery. We hope this will be a midwife from your team. However, midwives take on about four clients every month. Each woman has a 5 week timespan during which she would be considered term- or ready- to have her baby. This makes scheduling off-call time tricky, if not impossible. However, midwives, as much as we would love to be at our clients deliveries (after all, the relationships we form with our clients if one reason we love our jobs!), need time off-call. If we don’t take regular time-off, we are not able to rest so that we will be at our best at your delivery. Should you deliver while your midwife is off-call, another midwife from your team will be on-call to look after you. Very rarely, we experience periods of extreme busyness and none of the midwives on your team may be available. In this case, another one of our fantastic midwives will look after you until a midwife you know is available. You will be given the opportunity to meet the midwives on the other team during your care.
Q. What happens if I miss or am late for an appointment?
A. If you miss an appointment, you may reschedule it during a time your midwife has available. Please give as much notice as possible if you need to cancel an appointment. If you are a few minutes late for an appointment, your midwife will accomplish as much as possible during the time you have remaining. You will not receive your full appointment time, as this delays the rest of your midwife’s clinic. If you are 15 minutes or more late for an appointment, your appointment will be rescheduled.
Q. Do I need to take prenatal classes?
A. General prenatal classes offer information on nutrition, changes to your body during pregnancy, how labour works, strategies to cope with labour, breastfeeding, and newborn care. They are a fantastic way to not only prepare for childbirth and early parenting, but also to meet other women who are going through similar experiences. Many women find the friends they make through prenatal classes can provide a great support network throughout pregnancy and following delivery. There are many classes which focus on specific topics, like fitness, or strategies to cope with labour like hypnobirthing, or nutrition for you and your baby. Prenatal classes are not a requirement, but they can offer a lot whether this is your first baby or beyond.