What is a midwife?

The midwife is a specialist in normal childbirth. They are skilled practitioners who assesses, monitor and provide care during pregnancy, childbirth and the first 4-6 weeks postpartum. As midwives, we are dedicated to helping families define and access their individual health choices in the childbearing year.

"The practice of midwifery is the assessment and monitoring of women during pregnancy, labour, and the post-partum period an 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.

Do I need to pay for midwifery care?

Midwifery services are completely funded by the Ministry of Health and Long-Term Care, so clients do not pay for care out-of-pocket. People who are not currently covered by OHIP can still receive free midwifery care, however you may receive a bill for any lab work, ultrasounds or hospital care you may choose to receive.

What happens at a prenatal appointment?

During regularly scheduled visits to the midwifery clinic, midwives provide physical examinations and assessments, support and information. Appointments are on average 30-45 minutes long. Clients are seen 7-12 times throughout their entire pregnancy. 

What happens after my baby is born?

Midwives provide care for both clients and their babies for six weeks after the birth. Whether your baby is born at home or in the hospital, your midwife will provide care in your home with several visits in the first 7-10 days.  This allows for clients to rest and recuperate without having to travel outside the home or bring the baby to a clinic or hospital setting. For clients choosing to breastfeed, breastfeeding support is invaluable in the early days.  These frequent visits facilitate a successful breastfeeding relationship and challenges, if there are any, are caught and dealt with in a timely way.  Clients then see their midwives in clinic 2 or 3 times with the final visit scheduled at 6 weeks postpartum.   Midwives remain available by pager 24 hours a day, every day. After six weeks, clients are discharged from midwifery care and will see their family doctor for care. A complete summary of care is provided to the woman's family physician at the end of care.

What about drugs and technology?

Prenatally and during labour and birth, midwives follow best practice and provide evidence based care which results in low rates of intervention. We offer and can order the same routine tests and screens as any other obstetric care providers, including genetic testing, bloodwork, and ultrasounds. A midwifery client has all the  pharmaceutical options for pain management during labour that KHSC offers, including nitrous oxide, morphine and epidural, and can choose these and continue to have midwifery care. However, midwives also offer non-pharmocological forms of labour support, such as, hydrotherapy and water immersion, position changes, emotional support and hands on comfort measures that are shown to reduce to need for medical forms of pain relief. 

Midwives are able to prescribe certain medications when indicated.  For example, a midwife may prescribe an antibiotic to treat a urinary tract infection in pregnancy.  

Midwives use the gold standard in fetal surveillance in labour, intermittent auscultation, which involves listening to the fetal heart rate with a doppler device or a fetascope.  There is a large body of evidence which indicates routine use of continous electronic fetal monitoring (EFM) leads to an increase in interventions including cesarean section. However, in certain circumstances EFM is recommended and will always be discussed with client if such circumstances arise. 

Are midwives anti-hospital or technology?

No. Absolutely not! The best maternity care occurs when there is cooperation between midwives and obstetricians, whose specialized skills can be essential in high risk situations. Although most normal births require little or no intervention, midwives are trained in emergency skills and carry emergency equipment such as oxygen and resuscitation equipment, and anti-hemorrhagic drugs to all births. Hospital back-up and emergency equipment are important to the safety of home birth. Registered Midwives must practice in accordance with standards set by the College of Midwives. These standards include detailed guidelines about when to consult with or transfer care to a physician.

How are midwives trained and regulated?

Registered Midwives complete a four-year university degree offered at a number of universities throughout Canada.  In Ontario the program is offered through McMaster University, Laurentian University and Ryerson Polytechnic University. If a midwife has been trained outside of Canada, they complete the International Midwifery Pre-Registration Program, offered through Ryerson University. Once a midwife has completed training, they are registered through the College of Midwives of Ontario.  Newly Registered Midwives are required to complete a mentorship year within an established midwifery practice.  

Another option available to Aboriginal Midwives in Ontario is the four-year Aboriginal Midwifery Training Program at Tsi Non:we Ionnakeratstha Ona:grahsta’ Maternal and Child Centre on Six Nations of the Grand River territory.

Can I have a doctor AND a midwife?

In Ontario midwives, family practice physicians, and obstetricians are all primary health care providers and so you will see one of the above during your pregnancy, birth, and postpartum. You will not see a doctor unless a complication arises.  Your midwife will provide complete perinatal care for the pregnant person and newborn. If there are complications, midwives can consult or transfer care to a physician.  In these scenarios your midwife may provide shared care, or supportive care with the physician.

Can I have my baby at home?

Midwives in Ontario are proud to offer families a choice of setting for their birth. Families may choose to give birth in hospital, or at home. In our practice, approximately 25 to 30% of clients deliver at home.

Current research shows that home birth is as safe an option, for healthy low-risk pregnancies, as giving birth in the hospital. Our research is ever expanding and now shows that it may even have benefits over a hospital birth such as lower risk of infection, and lower rates of intervention.

For those clients interested in a homebirth, your midwife will discuss with you your options and whether or not you are an appropriate candidate for homebirth.  We also invite all clients considering homebirth and partners and family members to attend a homebirth information session.  These sessions are held regularly in our office.  Ask your midwife for more information.

Do you offer waterbirth as an option?

Yes.  The use of water in labour can be an extremely effective form of pain relief.  For women planning to labour at home or planning a homebirth, we offer the use of our inflatable labour pools.  These pools are specifically designed for labour and birth and come with a specially prepared kit.  Ask your midwife for more information.

KHSC now offers the option of water immersion for labour and birth. There are 2 labour rooms with birthtubs, which are available on a first come first serve basis.  Please speak with your midwife about this.

There is lots of great information available at  http://www.waterbirth.org

Am I too old or too young to have a midwife?

There are no age restrictions for accessing midwifery care. Anyone with a normal and low-risk pregnancy is eligible for a midwife. The majority of births are normal and low risk. 

This resource developed by the Association of Ontario Midwives is very helpful for those pregnant persons over the age of 40.

What are my options for Vaginal Birth after Cesarean (VBAC)?

Current evidence supports VBAC as a safe choice for the majority of people who have had a prior cesarean section.  The risks and benefits of both elective repeat caesarean section (ERCS) and VBAC and options for labour management are important components of informed choice discussions that will take place with your midwife.  There is also acknowledgement of the growing body of evidence that multiple cs have the potential to cause long-term harm.

The midwifery scope of practice as defined by the College of Midwives of Ontario (CMO) allows for midwives to provide prenatal, labour and delivery care and postpartum care to people who have had one lower segment transverse cesarean section (LSTCS).  A midwife may provide the same care for a person who has had two previous LSTCS however, the midwife must also consult with a physician and in this case, a transfer of care in labour is a part of KHSC hospital midwifery guidelines.