What happens when your care is transferred?
Registered Midwives practicing in Ontario have a defined scope of practice. A more detailed description of this scope is available in our client binder or on the College of Midwives of Ontario website, www.cmo.on.ca.
Situations may arise during your care with Madawaska Valley Midwives requiring your midwife to consult with a physician. This can occur during your prenatal care, during your labour and delivery, or at any point during your six weeks of postpartum care. A consult does not always result in a transfer of care. Your midwife will tell you when she is consulting with a physician and if there has been a transfer of care.
If the consult results in a transfer of care, the physician will be making the clinical decisions. Depending on the situation and the decision made by the physician it is possible that your midwife will continue to monitor your pregnancy or labour, and then communicate findings with the physician responsible. When there has been a transfer of care, the role of your midwife is to advocate for you and provide support.
A transfer of care can sometimes be a difficult experience. You may have envisioned your birth experience in a very specific way, which did not include numerous medical interventions with doctors you do not know. We understand the stress this can create and how challenging it can be to cope with the unexpected. Our role as your midwife is to help you understand why the changes are happening and to support you.
Some examples of when a prenatal consult or transfer of care might occur include:
- Twin pregnancy
- Attempting vaginal birth after cesarean
- High blood pressure, requiring medication
- Baby not growing adequately
- Baby in the breech position
- Gestational diabetes requiring insulin
- Placenta previa
- Unusual bloodwork, i.e. low platelets, antibodies
- Concerning results about baby on an ultrasound
- Existing medical conditions that may complicate your pregnancy and/or labour
Some examples of when a transfer of care in labour or postpartum might occur include:
- Premature labour before 37 weeks
- Induction of labour involving oxytocin
- Labour has slowed and you need oxytocin to augment
- There is difficulty in the pushing stage and you require assistance with vacuum or forceps.
- There are concerns about the well being of your baby
- Postpartum haemorrhage
- Suturing that is beyond our scope
When there is a transfer of care, and the concern is for your baby, a physician will make the initial assessment of your baby and determine the care plan. This physician will decide when it is appropriate for the care of your baby to be transferred back to your midwife. If your baby stays at Pembroke Regional Hospital you will be communicating with the nursing staff and the physician managing the care of your baby. Your midwife will remain in supportive care and you have the opportunity to communicate with her to ask any questions or express any concerns you may have.
If your baby is transferred to one of the Ottawa Hospitals, it is not possible for your midwife to visit you there. We are however, available by phone if you have any questions or concerns.
These are just some examples. The College of Midwives Standard on Consultation and Transfer of Care can be helpful in increasing your understanding of when a midwife will consult or transfer care to a physician. Click here to read more from the College of Midwives Standard on Consultation and Transfer of Care.