This Informed Choice Agreement is provided to explain our philosophy and services and to outline the responsibilities of both the midwife and the client. We are regulated by the College of Midwives of Ontario under the Midwifery Act, which was proclaimed on December 31, 1993. Because of this Act, midwifery services are available and funded for Ontario residents.
We follow the regulations and standards for midwifery care as laid out by the College of Midwives of Ontario, which include screening for risks and consulting with other practitioners when necessary. These standards and our practice guideline are available at request. We offer complete midwifery care during pregnancy, labour, birth and the postpartum period. Our care involves physical assessments, lab work, time to address your questions, and discussion of a number of topics such as,
- nutrition, exercise and lifestyle issues
- normal physical and emotional changes
- diagnostic procedures and medical interventions
- preparation for labour and birth
- abnormalities, complications and emergency measures
- infant care and breastfeeding
- postpartum adjustment and parenting
- fertility awareness and family planning
Pregnancy care includes regular visits, approximately once a month until 28 weeks gestation, then every two weeks until 36 weeks gestation, then weekly until the birth. Our clinic appointments give us ample time to provide clinical care and address discussion topics. We strongly encourage both partners to be present, and welcome other family members.
During active labour we are in attendance to provide clinical care, reassurance, and an extra pair of loving hands. After the birth, we stay until confident that the mother and baby are stable and adjusting well. Your postpartum care includes several visits during the first week, which can take place at home and/or hospital, wherever you are. Following that, you and your baby will be seen in clinic for additional visits prior to completion of our care at six weeks postpartum. We welcome phone calls during the baby’s first months to assist in making the transition to parenting as smooth as possible.
Midwives are primary healthcare providers for pregnant women, it is therefore unnecessary for you or your baby to see a physician for additional obstetric or newborn care until your baby is 6 weeks postpartum. Any concerns relating to pregnancy and postpartum should be directed to the midwives. We will refer any medical concerns relating to the pregnancy, birth, or postpartum to the appropriate specialist. If care must be transferred, we continue to provide advocacy and support. In the case of non-pregnancy related concerns, we will refer you to your family doctor or another health care provider. We also refer clients to chiropractors, physiotherapists, homeopaths, acupuncturists, massage therapists, lactation consultants, and others as appropriate.
You are welcome to use our library, consisting of books, DVDs and videotapes. During the course of your care we may recommend various readings and viewings that are relevant to your individual needs.
The Madawaska Valley Midwives work in a team, shared care model and work on a schedule that rotates between being in clinic and working on-call/attending births. Each client will be assigned to a team of two midwives and the vast majority of care will be provided by your team. During prenatal care, clients will have the opportunity to meet the midwives of the other team. When in labour, clients have a 90 percent chance of having one of their team midwives be the primary midwife at their birth. Only in extenuating circumstances will a client’s primary midwife at her birth be from the other team.
Your midwives are available to you, for your individual pregnancy related needs, 24/7 by pager. We have one pager number and the on-call midwife for your team will receive your page and respond promptly. Your midwife will determine the appropriate course of action and make referrals as appropriate. When you go into labour, your team’s designated on-call midwife will be the primary at your birth.
There are two midwives at each home birth, the primary staying with the woman during active labour, and the second arriving closer to the time of birth. To preserve the well-being of the midwives by allowing for some time off-call, we utilize either nurses or second birth attendants as back-up, depending on choice of birth place. Second birth attendants are people with experience in birth who are not midwives, but are authorized by the College of Midwives of Ontario to assist at births. You can find biographies of our second birth attendants on our website (or in our binders) and can access the College of Midwives standard on second birth attendants on their website (www.cmo.on.ca).
We make every attempt to attend each of our clients in their desired birth place. However, because we are such a small practice in such a large geographic area, times may arise when we are unable to honour a woman’s birth plan. For example; when we have two women in labour simultaneously, we will make every effort to attend both women by utilizing our second birth attendants, but on occasion, we may need to ask a woman planning a homebirth to move into hospital. We also need to take into consideration extreme weather conditions, accessibility of the woman’s home, and distance from home to hospital when deciding whether home birth is appropriate.
There is always a midwife available 24 hours a day, 7 days a week for urgent needs. We ask that non-urgent calls and scheduling/changing appointments be made during weekdays through our clinic phone line.
The nature of the service we provide means that occasionally it may be necessary to rebook your appointment, for example, when another woman is in labour. Although it can be frustrating to have your appointment canceled, we ask that you consider that when you are in labour, we may be canceling appointments in order to attend to you.
It is advisable to call our message centre before leaving for your appointment. The message will inform you of any cancellations. Your midwife will be in touch with you to reschedule your appointment.
Midwives tailor the care they give to the individual client. It is important for you to tell us what your expectations are, and to keep us informed of any situations that could affect your care. It is your responsibility to ask questions and make final decisions about your care and that of your baby. Our role is to help you access the information you need to make those choices.
Clients are responsible for their health and that of their babies, which includes paying attention to diet, rest, exercise and regular prenatal care. During pregnancy we request that you learn about the process of pregnancy, labour and birth, relaxation techniques, postpartum adjustment, infant care and breastfeeding. Prenatal classes, breastfeeding clinics, and readings are recommended.
Around 20–30 weeks gestation, your midwife will give you a copy of your antenatal records to carry. We think this is a good idea so that if for any reason you find yourself at a hospital, your records are with you and all the pertinent information about your pregnancy is easily available. We suggest you tuck them securely away in your purse or wallet. Once in your hands, it is your responsibility to keep your records safe and confidential.
The Madawaska Valley Midwives have admitting privileges at the Pembroke Regional Hospital. In keeping with the College of Midwives of Ontario, we offer women the choice of homebirth or birth at Pembroke Regional Hospital.
Birth is not inherently a dangerous process, but 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. Click here to find out more information about the safety of homebirth with midwives.
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.
Scope of Practice, Standards and Transfer of Care
Midwives must practice within the scope developed by the College of Midwives. Click here to see the standards laid out by the College of Midwives of Ontario. One document that we would particularly like to bring to your attention is the Standard on Consultation and Transfer of Care. This informs midwives when they have to consult or transfer to a physician.
In addition to the College of Midwives guidelines for transferring care to a physician, there are some guidelines for transfer of care which are mandated by the Pembroke Regional Hospital.
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, including clinical decisions. 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.
All professional communication with clients is kept confidential. Specific information regarding your situation is shared with professional colleagues who are providing you with care. You are free to examine your chart at any time, and a copy will be available for you after your last visit.
If we use a birth story as a tool for educating other families and midwives, this is done discreetly, without reference to names or places. If you do not want your story used, please tell your midwife.