Informed Choice Agreement

Choosing midwifery care means you are choosing a distinct style of maternity care. Your decision to work with a midwife should be an informed decision. We are providing you with information about our education, training, experience and the services we provide. Please read this Informed Choice Agreement carefully and, if you have questions, discuss them with your midwife.

Midwifery care is based on a respect for pregnancy as a state of health and childbirth as a normal physiological process and as a profound event in a woman's life.

What Is a Midwife?

A midwife:

  • Sees pregnancy and childbirth as a normal physiological process
  • Respects and supports women so that they may give birth safely, with power and dignity
  • Is a trained professional who provides complete and comprehensive care to women through all stages of pregnancy and birth and continues to care for both mother and baby for six weeks postpartum.

The international definition of a midwife:

  • ...[she] has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. She must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, 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 counseling 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 hospital, clinics, health units, domiciliary conditions, or in any other service.


LEGAL STATUS

The Midwifery Act is part of the Regulated Health Professions Act of Ontario which was proclaimed on January 1, 1994. Since proclamation of the Act, midwives are required to be registered with the College of Midwives of Ontario. Midwifery care is now publicly funded through the Ministry of Health.

Scope of Practice, Standards and Transfer of Care

Midwives must practice within the scope of practice developed by the College of Midwives. The "indications for mandatory, discussion, consultation and transfer of care" are available to borrow and read. Please ask your midwife for a copy.

In addition to the College of Midwives guidelines for transferring care to a physician, there are, for the midwives in Ottawa, some guidelines for transfer of care which are mandated by the Montfort Hospital. Please discuss this list with your midwife.

If your midwife transfers your care to a physician this means that the physician becomes your primary caregiver instead of your midwife. For this period of time, your physician and/or nurses provide your care and monitoring. Your midwife’s role is to advocate and support. Care may be transferred back to the midwife when appropriate and when agreed upon by all parties.

Midwifery Care ~ Appropriate Use of Technology

Prenatally, midwives provide "low intervention" care with appropriate use of technology where clinically indicated.

In labour, midwives work together with women, their partners and support people. During labour and birth, midwives use alternative comfort measures in order to reduce the need for medications.

The use of technology and drugs is sometimes necessary and is always open to midwifery clients when needed. The emphasis in midwifery care is on birth as a normal physiological process and an important life event and in supporting women to make informed choices.

Prenatal Care ~ Where, What, When, Who

We provide prenatal care in our clinic.

Prenatal Care plays an important role ...

  • In learning about the changes your body goes through as pregnancy advances.
  • In preventing and detecting problems which can arise in pregnancy.

Our care includes the monitoring of fetal growth, fetal heart rate and position, and, for the mother, urinalysis, blood tests, blood pressure, ultrasound (depending on request and indication), and general health. We can provide counseling and advice on nutrition, exercise, and the social and emotional aspects of pregnancy.

  • If you have been seen by another caregiver before you came to our practice, we will request a copy of your records.
  • Clients may expect to see a midwife at least once a month until the 28th week of pregnancy, every 2nd week until the 36th week and once a week until you have your baby.
  • During your prenatal care you will meet 4 midwives. Two of these midwives will work as a team so that one of them will be the primary midwife attending your birth (depending on the on-call schedule).

Labour and Delivery Care ~ Where, What, When and Who

We have privileges at the Montfort Hospital and provide labour and birth support in both home and/or hospital.

During labour, at home or at the hospital, the midwives are responsible for monitoring maternal and fetal well-being. Two midwives are present at all births except under exceptional circumstances when a 2nd Attendant may assist your midwife.

Second Birth Attendants are certified in neonatal resuscitation and cardio-pulmonary resuscitation. They fulfill the Guidelines for Second Birth Attendants of the College of Midwives. (These are available for you to read).

Postpartum Care ~ When, Where

We visit you in the immediate postpartum period at home; further postpartum follow-ups will take place at the clinic. Should any problem arise, we are always available by pager.

It is important as part of your preparation for breast-feeding that you check out local community resources such as La Leche League, your local well baby drop-in centres (public health department) and the numbers of Lactation Consultants.

Although your midwife is your primary resource for breast-feeding help and support during the postnatal period and should always be accessed first, there may be times when she is committed to supporting other clients through their labours and births and be temporarily unable to respond when you and your baby’s need is greatest. At this time you should feel comfortable accessing breast-feeding help from the resources you have identified.

You will find a list of breastfeeding resources in your introductory package.

Choice of Birth Place

There are distinct risks and benefits to any birth place. It is the responsibility of parents to become as informed as possible, to weigh those risks and benefits and to make decisions appropriate to themselves.

Some medical practitioners and organizations believe home birth poses added risks. The available research indicates that planned home birth is a safe option for, low risk, healthy mothers. The Ontario Ministry of Health and the College of Midwives supports choice of birthplace.

Deviation from the normal can usually be identified prenatally and in labour. Most problems are not life-threatening and can be dealt with at home. In some instances moving to hospital is the most appropriate decision. There are circumstances when use of the technology available only in tertiary care hospitals may be essential for the safety of mother and/or baby.

We can provide you with detailed information about some of the problems which may arise and, we encourage you to discuss with us our experience in dealing with them.

Client's Role and Responsibility

  • Clients are asked to actively participate in decision making about their care.
  • Clients are expected to maintain good health during their pregnancies. A balanced diet, adequate rest and exercise contribute to healthy pregnancies. Clients should receive regular prenatal care.
  • It is beneficial for expectant parents to educate themselves on pregnancy, labour and birth either through prenatal classes or self-education. You are invited to use the clinic lending library which includes books and videos.
  • Before coming to a morning clinic appointment, call the office to find out if your midwife has had to cancel her appointments on short notice. When an appointment is canceled you will need to call the office to book a new appointment.

Midwives' care is individualized. It is important for you to make her aware of your expectations.

  • In order to be effective caregivers we ask that clients keep us well informed of problems or situations that may affect their care.
  • There are times when birth plans have to be changed. These may involve choice of birthplace (i.e. from home to hospital) or caregiver (i.e. from midwife to physician). We will explain any of these changes if they happen.
  • If you are dissatisfied with your care we encourage you to discuss this with your midwife. We welcome constructive criticism. We value feedback and encourage you to honestly fill out the questionnaire you will receive at your final postpartum visit.

Consumers of midwifery care will always need to play an important role in protecting the midwifery model of care.

  • We encourage you to join the Ontario Midwifery Consumer Network (OMCN), a consumer lobby group. We occasionally loan our mailing list to the local OMCN Chapter. If you do not wish your name to be on the mailing list please let us know. Contact the Consumer network at info@midwiferyconsumers.org.

Holidays and Time Off Call

Midwives take holidays on a regular basis throughout the year. During each month the midwives will have an on-call/off-call schedule. This schedule is based on the midwives in this practice working in a team. Your Primary and Third midwife will form a team that will be on-call for births for one week at a time, while your Second and Fourth midwife will be on-call on the alternating weeks. The team of midwives that is not on-call for births and postpartum visits will be available for prenatal and postpartum appointments in the clinic, as well as for answering questions and requests that are non-urgent. Time off call will be scheduled when midwives need to attend important conferences and professional meetings, these sometimes occur at short notice.

Client Records

Your midwifery records are your property. You may have access to them at any time. If requested, we will provide you with a photocopy at your last visit.

Confidentiality

We respect each client's right to complete confidentiality. However, a large part of our work involves educating women and their families about pregnancy, birth and parenting. One of our most useful tools in teaching is telling anonymous birth stories or showing photos shared with us by parents. Please let us know if you are not comfortable with your story or photos being used in this way. We also support the study of birth related topics and midwifery care and your records may be available anonymously for research and statistical analysis.

The midwives of this practice meet on a regular basis with other midwives to discuss problems and topics of interest. At these meetings (peer review) your situation may be discussed anonymously.

It is important you feel safe when disclosing information to your midwife please let us know how we can facilitate this for you.

We encourage all clients to plan to attend at least one appointment by themselves so that there is an opportunity to discuss any privacy issues with their midwife.

Student Midwives

Our practice, like in the majority of the province, is a teaching practice. We may have two or three students each year from the University based midwifery education program. As part of their clinical education they will be involved in all aspects of your care. They will always work under the supervision of one of the registered midwives, also known as preceptors. We appreciate your support in our endeavors to have well trained future midwives.

The Midwifery Collective of Ottawa is a teaching practice, which means that student midwives may be involved in your care. Depending on their level of expertise, they may be observing at your prenatal visits, labours, births, and the postpartum, or as they advance through the programme, be taking on the responsibilities of a primary midwife. During the last year of the university programme, students are expected to be more autonomous, moving toward being an independent practitioner, in which case they will be responsible for co-ordination your care under the supervision of their preceptor. As a client of the Midwifery Collective, you should be aware that you always have access to a registered midwife and should feel comfortable contacting or paging her at any time. Should your known primary midwife be unavailable due to other commitments, you may contact any other of the midwives at the Collective in order to have your immediate concerns addressed.