Midwife regulations in Ontario? - Page 2

[Ola_]

Originally Posted by 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.

Thanks for the advice, I'll have to look into that!

Originally Posted by mwherbs

it probably cannot be stated enough that it depends on the midwife

Yeah, I'm getting that impression. I think I'll have to cross my fingers and ask a lot of questions. Thank you everyone for your input!

[TO Doula]

Originally Posted by mamabadger

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.

The problem is that a midwife's scope may be limited by her admitting hospital. The College of Midwives of Ontario says that a midwife may remain in care of a woman up to 43 weeks, but if her hospital won't play ball with that her hands are effectively tied. If she loses her admitting privileges, she can't do births at all.

[TO Doula]

Originally Posted by 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 ---

Of course some things depend on the midwife, but it also depends *a lot* on her admitting hospital. Some hospitals will support HBAC, others not. I know midwives who themselves are comfortable with HBAC, but if they ever transferred in from a planned HBAC and the hospital figured out what was going on they'd lose their privileges in a heartbeat.

So, in Ontario a midwife's scope of practice is initially set by the CMO, but then further restrictions can be imposed by the hospital where she has admitting privileges.

Part of the problem for women here is that there aren't enough midwives to go around and they book up so quickly that women don't really get the chance to interview and pick a midwife they're comfortable with. You just pick ob/gp/mw as a concept, and then take pot luck on the actual practitioner.

[mamabadger]

Originally Posted by TO Doula

The problem is that a midwife's scope may be limited by her admitting hospital. The College of Midwives of Ontario says that a midwife may remain in care of a woman up to 43 weeks, but if her hospital won't play ball with that her hands are effectively tied. If she loses her admitting privileges, she can't do births at all.

Unfortunately, the bill licensing midwives in Ontario made independent midwives illegal, leaving a lot of women with nowhere to turn if they do not want to be induced or hospitalized.

[MamaKickyPants]

Originally Posted by mamabadger

Unfortunately, the bill licensing midwives in Ontario made independent midwives illegal, leaving a lot of women with nowhere to turn if they do not want to be induced or hospitalized.

I'm not sure what you're getting at here - Being in the care of a midwife in Ontario does not mean you will be hospitalized and induced. I hope that's not what you mean and I'm mis-reading. Every midwife I know would work their butt off to keep their clients from being induced and to allow them to birth in the setting they choose (be it home or hospital).

[triscuitsmom]

Originally Posted by MamaKickyPants

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. Bt the protocol is transfer to an ob at 42 wks. Do you have a midwife yet?

Breech birth here is scary. A friend of mine had a local midwife tell her she "had to" get an ultrasound to verify position before birth (she was having a difficult time herself) because if her baby presented bum first in her planned homebirth she would hold him/her in until they got to the hospital in an ambulance even if she was pushing

As for postdates, others have covered it... according to the CMO a consult with an OB is appropriate at 42 completed weeks. Homebirth is acceptable up to 43 completed weeks.

Originally Posted by TO Doula

Of course some things depend on the midwife, but it also depends *a lot* on her admitting hospital.

Yes Yes and Yes again. There is a LOT of this happening here. Stuff the midwives are fine with the hospital OBs are making a huge stink about and watching for them to do anything to call them in on.

Originally Posted by MamaKickyPants

I'm not sure what you're getting at here - Being in the care of a midwife in Ontario does not mean you will be hospitalized and induced. I hope that's not what you mean and I'm mis-reading. Every midwife I know would work their butt off to keep their clients from being induced and to allow them to birth in the setting they choose (be it home or hospital).

I can't speak for the OP, but I read it as (and I agree) that by having no access to midwives who work outside of the system those who aren't being served by the system have no accessible options. Like those who want VBACs or breech homebirths or delivery of more than a singleton at home or are further postdates than the midwives can work with. For instance the CMO says 43 weeks is acceptable for homebirth but that a consult needs to happen with an OB at 42 weeks. That in effect here means that the midwife who's client refuses induction at 42 weeks has now been red flagged and if anything necessitates a transfer into the hospital after 42 weeks life is made very very difficult for both the client and the midwife. Also it is public health law to get the eye ointment into every baby's eyes after birth. I refused. The first place I delivered they didn't care, hospital or home. The second they do, and if any midwifery client does not get it documented as done they are being reported even though it was client choice to refuse it. (Both times I had a hospital birth with a midwife, but in different Ontario cities).

There are certainly pros to having midwives as part of the "system" but there are certainly cons too. It really depends on where you are sitting.

[mamabadger]

Originally Posted by MamaKickyPants

I'm not sure what you're getting at here - Being in the care of a midwife in Ontario does not mean you will be hospitalized and induced. I hope that's not what you mean and I'm mis-reading. Every midwife I know would work their butt off to keep their clients from being induced and to allow them to birth in the setting they choose (be it home or hospital).

Triscuitsmom summed it up well. Midwives are sometimes put in a position of having to refuse women certain options, if they want to continue in practice.
For example, the local hospital insists that midwives transfer home birth clients to hospital if they have not delivered by 42 weeks. I hear from a lot of women doing everything they can think of to get labour started before their time runs out and they have to settle for a hospital birth. Midwives are also unable to accommodate their clients' requests for home VBAC, breech, or twin births, if they want to keep their hospital privileges.
One couple who were clients of mine were unable to find Ontario midwives who could help them with a natural breech birth. Hospital policy tied the midwives' hands. The couple temporarily set up residence near the U.S. border, eight hours from home, so they could cross the border during labour and deliver with American lay midwives.
I do not mean to criticize the Ontario midwives themselves, or their dedication to their clients, but the system they work in has its limitations.

[Joyster]

Originally Posted by 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!

I'm with Sages Femmes, they were recommended to me by a friend. I'm not thrilled with my primary and have posted about her before. LOVE my secondary midwife though. I saw her today and I came out floating, I have to see my primary in a couple of weeks and have had to come to a state of mind where I'm at peace that they'll both be with me when I deliver so I'll have to focus on the good. They're with Rouge Valley, so if that means Ajax-Pickering hospital for you then there you go. I'm in Scarborough so I'll be at the Centenary site...unless I happen to be in Ajax at the time I go into labour.

[caiesmommy]

Originally Posted by 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!

I'm in Bowmanville. I'm not sure where in the DR you are. I used Community Care Midwives for both my babes HB and I LOVE Judy! I believe a new midwife that joined the practice after I birthed dd posts on this forum. Community Care covers Oshawa hospital to Coubourg hospital. And your home. I HB'd both babies ds being strep b positive, dd with a bedrest/risk of being premmie hard pregnancy. Judy would come to my home for dd and have to literally put my butt under a pillow and push her back in it was horrible. BUT she was even nice enough to bring me lunch(veggie taco bell) b/c she knew it was the only thing I could keep down.

http://communitycaremidwives.com/

I HIGHLY suggest her practice. If you go to rate my dr. She has like a 9. something. BUT you have to book instantly. I was so lucky with ds and got the last spot for the month. I say pee on the stick and call the midwife...seriously!

A new midwives office did open up here in bville in Jan(?). I have checked it out a bit, a friend called them but they wouldn't answer a simple question over the phone they wanted an appt. which friend couldnt make..so that was the end

[Ola_]

Originally Posted by Joyster

I'm with Sages Femmes, they were recommended to me by a friend. I'm not thrilled with my primary and have posted about her before. LOVE my secondary midwife though.

Hmm, interesting. I don't think I have any choice over who will be my primary, will I? Off to read some of your posts.

Originally Posted by caiesmommy

I'm in Bowmanville. I'm not sure where in the DR you are. I used Community Care Midwives for both my babes HB and I LOVE Judy!

I'm in Pickering so I think we're out of their area unfortunately... I'm definitely going to check out the rate my dr site though!

[Joyster]

Originally Posted by Ola_

Hmm, interesting. I don't think I have any choice over who will be my primary, will I? Off to read some of your posts.


I'm in Pickering so I think we're out of their area unfortunately... I'm definitely going to check out the rate my dr site though!

I don't know, I doubt it, it's probably luck of the draw. My friend who had a different team really liked them. I'm not sure what is going on with my primary and me, and I'm being a wuss in addressing the issue head on, so hopefully you won't run into the same issues if you chose them.

[sweetsadie77]

We try to honour requests for specific midwives as best we can, though with holidays and only taking a limited number of clients per month it isn't always possible.