Midwife regulations in Ontario?

[Ola_]

Since midwifery is regulated in Ontario, what kinds of things are they not able or must do, compared to a CPM or similar?

I'm reading the official websites and they all talk about the woman being the main decision maker, informed consent, etc. That's excellent, but I'd like to know where the limits are. Things like when transfer to a hospital is required or when they must transfer care to a physician. Some of my concerns are about going "post dates", giving birth in water (vs. just labouring in water), breech baby, stuff like that.

I was thinking specifically of a homebirth situation but experience/info for either home or hospital is welcome.

[MamaKickyPants]

I'm not Sure what a CPM is so can't speak to that but I'll attempt the rest. At a homebirth there s no question that you could deliver in the water f that's what you want to do. There are protocols for transfer to the hospital but is specific to the scenario. S there something in particular you are wondering about? Breech birth is a tranfer of care, althogh if you insisted on attmepting to deliver a breech baby at home I don't think they can refuse you care. Most women would tranfer to an on for breech bt the mw would contnue to support and would take over care afterwards if everything was straightforward. There ar a few obs in Toronto who will attend a vaginal brech delivery but the process s a bot complicated. My son was breech and we had our midwife do an ECv and we were able to turn him. Post dates s similar to breech in that I don't know if they can refuse you care. Bt the protocol is transfer to an ob at 42 wks. Do you have a midwife yet? I recommend getting one right away as the waiting lists can be long. I can recmmend someone in Toronto if that's where yu are

[Ola_]

No midwife yet, we're still TTC. But I have heard to call ASAP as they book up quickly! I'm in Durham region actually and I've got a list of a couple practices here, but if there are some you would recommend over others that would be great to know!

[MamaKickyPants]

Hmm I don't know Durham that well - just the city of Toronto. I can ask around to my 'connections' - My mom and my sister are both midwives! Good connections They really are serious when they talk about informed choice and women being the decision makers. You are fully in charge - it is unlike any other health care experience. The ontario model of midwifery care is really good, IMO (I may be a bit biased, but I'm also a consumer, and our midwife attended homebirth was a wonderful experience).

[mwherbs]

so one of the more important differences is at home or in the hospital the same midwife can take care of you including meds- if you want or need them- I have a long time friend who took her CPM/LM status and worked to get it up to speed for Canada and now she works in a practice that has quite a high homebirth rate- which is what she wanted

[limette]

Here they won't do a breech vaginal birth. It's automatic c-section.

Where I am in Northern Ontario, it's been a struggle to get them to agree to a homebirth vbac. They Ontario midwife college supports the choice but the midwives here a scared of the backlash from the rest of the medical community if something goes wrong. I'm actually the only person here to ever attempt an hbac.

They have a list that they give out that says what they will consult on and what they will transfer (to an ob) on. I can't remember what's on the list but I'm sure you could call one and get them to fax it to you.

Again, although there are certain rules/standards that the all the midwives in Ontario are supposed to follow, it all depends on the individual midwife on what flies with them. My current ones don't care about heplocs for vbac moms (they think it's a stupid requirement), whereas the ones I was with last time would not let the issue drop (when I refused it).

For all 6 of my midwives, none of them blinked when I refused blood tests, the gd test or the strep test.

[NorthernPixie]

As limette said, I think it depends a lot on the midwifery practice, and even then on the specific midwife. I'm in Ottawa and planning an HBAC, but it was hard to find a midwife who would do that (thankfully I did). Apparently not many will attend home VBACs. I don't think that breech means transfer of care in Ottawa either, although it's preferred to be at the hospital (but my MW said she wouldn't refuse me either, if I insisted on being at home). Also, after 43 weeks a homebirth wouldn't be appropriate. So it seems like it varies quite a lot. Do your research before you even get that positive test so you know right away whom to call, and good luck!

[nutritionistmom]

This may be helpful to you:
http://www.cmo.on.ca/downloads/commu...er%20Jun00.pdf

[Tizzy]

This may answer some questions:

http://www.communitymidwives.net/ind...r-of-care.html

[sanguine_speed]

[Ola_]

Thank you ladies, these links and info are excellent!

MamaKickyPants, the two MW practices in our area that I know of are Sages-Femmes Rouge Valley Midwives and Midwifery Services of Durham. I'd be curious if anyone has a strong recommendation or caution for either. I'm leaning towards the Sages-Femmes because I think they have priviledges at the Ajax-Pickering hospital which we are closer to. But I realize I may just need to go with whichever one that has room for me since they're so busy!

[MamaKickyPants]

I'm asking around about those two practices. I'll let you know soon.

[Defenestrator]

One of the midwives of sage femmes rouge used to post here a lot and she sounded pretty wonderful.

[MamaKickyPants]

My sense is you might be happier at Sage-femmes rouge valley, if you have a choice. You can find out if either of the practices is 'full-scope' meaning they have more autonomy and control if you need to be in the hospital.

[neveryoumindthere]

i just gave birth 5 days ago and was 42 wks...

the m/w said at 42 weeks they have to consult an OB not necessarily transfer.

[mamabadger]

Originally Posted by neveryoumindthere

i just gave birth 5 days ago and was 42 wks...

the m/w said at 42 weeks they have to consult an OB not necessarily transfer.

Local midwives are claiming they have to transfer to hospital at 42 weeks. I have clients doing anything they can think of to bring on labour once they pass 41 weeks, so they can have a home birth.

[limette]

Originally Posted by sanguine_speed

It is not.

The most recent guidelines:
http://www.theglobeandmail.com/life/...rticle1186104/

Besides this, no woman can be cut open without her consent, and no woman needs permission for a baby to come out of her vagina.

You may have a hard time finding a willing or skilled doctor to attend your birth, and I appreciate the hard decision it is to refuse a c-section if you're faced with unwilling, unskilled doctors, but a c-section is not "automatic" for breech.

I chose to have my breech baby vaginally with a doctor and hospital that "doesn't do that". By being at the hospital I had access to neonatologists who were literally behind the curtain. I could not be forced to have a c-section, but that doctor could be and was forced to attend my vaginal breech birth. Here, you cannot be abandoned care for such a choice. He didn't like it, but it wasn't up to him any further than his choice to be an OB/GYN in our jurisdiction including all of the rules and guidelines that apply to his profession, including not being allowed to abandon care.

The midwives here will not attend a breech birth and the obs may not strap you down and cut you open but I can guarantee the birth with one in attendance will not be pleasant.

They don't care about the latest guidelines. Like I said technically the midwives offer hbac but they will argue it to death to convince you not too and when you still insist, they show up at your birth and harass you into transfer.

[neveryoumindthere]

I guess it depends on the midwives..my bff had an hbac/waterbirth a couple years back

[tankgirl73]

A lot does depend on the individual midwife. My daughter was born in Hamilton, the midwife I got was excited about and loves waterbirths, but there are others who will refuse to do them. Certain specific things are contraindicated for midwifery (ie, "complicated" pregnancies or certain health issues like high blood pressure -- I just snuck in with that one), it has to be "normal". And there are specific guidelines for when transfer of care needs to happen. But anything that's not specifically spelled out is up to the particular comfort level and training/experience of the individual midwife.

Like, my midwife was comfortable with my request to not have antibiotics at the birth ... since I'd refused the group B strep test, giving IV antibiotics is "standard" but you can request not to do it. She told me though, that one of the other midwifes on my 'team' would absolutely not allow that... if she ended up attending my birth, it would be antibiotics straight away, no argument.

So do talk things over with your midwife. They should give you detailed information about the 'rules' for transfer of care, I had to sign a form as I recall, or at least she had to check off some boxes on a form, stating that we'd gone over all that stuff.

In our case, we had a home waterbirth planned and she was fine with all of my non-intervention preferences. She was fantastic. Then my blood pressure shot up. Midwives do have hospital privileges, but that's a transfer of care situation. She got me an appointment with an OB they trust to check things out, and she also filled me in on what was likely to happen, she was extremely sympathetic and supportive and reassured my fears.

I ended up needing a transfer of care, was admitted to the hospital for an induction. It was traumatic to me after my fervent hopes for the home waterbirth, but it was SEAMLESS. It was not difficult (red tape-wise), the OB was not offended that I was with a midwife or anything like that, or critical of my choices at all... they're used to the model.

There were SOME issues in the hospital, of course. The drs and nurses didn't want to let me deliver squatting... but I insisted. AND my midwife stayed with me -- though she was not the one 'in charge', she was part of the team and served a sort of doula role for me. This is an example of how the Ontario model really is wonderful -- even when I needed the transfer of care, I was able to keep the person who I had worked with all along, beside me. It really helped me be comfortable.

THEN, the instant that my daughter was born, the care transferred automatically straight back to the midwife! So even though my daughter was born in the hospital with an OB and a medical induction... my midwife did all my home visits and I went to her office for the post partum chechkups.

I really think it's a great model. Best of both worlds. The midwives can handle all the 'normal' situations, but when medical care IS needed, it's seamless and painless to transfer. It was surprisingly uncomplicated.

[mwherbs]

it probably cannot be stated enough that it depends on the midwife- my long time friend is completely supportive of HBAC and vaginal breeches she is pretty hard core homebirth ---