Midwife regulations in Ontario? - Mothering Forums

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Old 05-25-2010, 05:57 PM - Thread Starter
 
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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.
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Old 05-25-2010, 06:09 PM
 
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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

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Old 05-25-2010, 06:26 PM - Thread Starter
 
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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!
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Old 05-25-2010, 07:08 PM
 
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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).

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Old 05-25-2010, 07:25 PM
 
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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
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Old 05-25-2010, 08:19 PM
 
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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.
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Old 05-25-2010, 11:02 PM
 
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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!
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Old 05-26-2010, 01:40 PM
 
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This may be helpful to you:
http://www.cmo.on.ca/downloads/commu...er%20Jun00.pdf

Kelly - Children's Restraint Technician Instructor - Mom to my December boys
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Old 05-26-2010, 05:25 PM
 
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This may answer some questions:

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

DH and I - totally winging life with our four children, DS1 (6.5yrs), DS2 (5yrs), DD (3yrs) and DS3 (1)!

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Old 05-26-2010, 05:32 PM
 
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4 kids under 10
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Old 05-26-2010, 06:20 PM - Thread Starter
 
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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!
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Old 05-27-2010, 10:48 AM
 
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I'm asking around about those two practices. I'll let you know soon.

Lindsay, mama to Owen (06.08) and Sadie (05.11) wool.gifpartner to the amazing J. 
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Old 05-27-2010, 10:56 AM
 
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One of the midwives of sage femmes rouge used to post here a lot and she sounded pretty wonderful.

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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Old 05-27-2010, 08:00 PM
 
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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.

Lindsay, mama to Owen (06.08) and Sadie (05.11) wool.gifpartner to the amazing J. 
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Old 05-27-2010, 08:13 PM
 
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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.

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Old 05-28-2010, 01:37 AM
 
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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.
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Old 05-28-2010, 11:25 AM
 
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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.
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Old 05-28-2010, 12:23 PM
 
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I guess it depends on the midwives..my bff had an hbac/waterbirth a couple years back

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Old 05-28-2010, 01:01 PM
 
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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.

Heather, mom to Caileigh 12/06 and aspie ADHD prodigy David 05/98 :intact lact
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Old 05-28-2010, 05:58 PM
 
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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 ---
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Old 05-30-2010, 12:02 AM - Thread Starter
 
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Originally Posted by MamaKickyPants View Post
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!

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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!
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Old 05-30-2010, 10:23 AM
 
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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.

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Old 05-30-2010, 10:31 AM
 
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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.

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Old 05-30-2010, 03:15 PM
 
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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.
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Old 05-30-2010, 07:18 PM
 
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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).

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Old 05-30-2010, 08:52 PM
 
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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.

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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.

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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.

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Old 05-31-2010, 04:23 AM
 
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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.
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Old 05-31-2010, 06:19 PM
 
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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.

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Old 05-31-2010, 06:40 PM
 
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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

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Old 05-31-2010, 06:47 PM - Thread Starter
 
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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.

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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!
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