Our Practice ↑
Our practice includes a growing number of registered midwives and midwifery students. As low-risk obstetrical healthcare providers, we conduct births either in your home or in the hospital setting. Our practice group has hospital privileges at North York General Hospital.
To enhance continuity of care, clients will usually alternate their prenatal and postnatal appointments between their two or three assigned midwives. This ensures you know at least two midwives well.
Two midwives will attend your birth, and at least one of those midwives will be your known midwife. In the very unlikely event that both of your midwives were unavailable, emergency backups with other midwives from the practice would be arranged.
Your midwives are on call 24 hours a day, seven days a week. However, each midwife regularly takes two 3-day weekends off call per month. Every effort will be made to ensure that both of your midwives are not off call simultaneously.
Midwives do not normally book clients during their scheduled holidays. In order to cover overlap around holiday periods, some alternate arrangements might be made. You should discuss those specifics with your midwives.
We feel it is vitally important to educate new midwives as the demand for midwifery services increases. Our practice is a teaching practice and participates in the education and supervision of midwifery students. You will meet and get to know the students who are working in our practice. If a student is attending your birth, it will be someone you know and have met prenatally as part of your “team” of midwives. Students are involved in all aspects of midwifery care, including prenatal, labour and birth and post-part care with supervision dependent on their level of study.
Prenatal Care ↑
Prenatal care is a good idea for all women preparing for birth. It allows the health of both mother and baby to be monitored, and for possible problems to be picked up early and preventive measures instituted. Prenatal care also gives the woman and her family education about the changes in her body and the baby as the pregnancy advances.
Our care includes monitoring blood pressure, fetal growth, heart rate and position, urinalysis and the general health of mother and baby. We see all clients at least once a month until the twenty-eighth week, every second week until the thirty-sixth week, and once a week thereafter until the baby is born. If you developed any complications in a previous pregnancy, we request that you obtain records of your birth from the midwife or physician who provided your care. We will arrange or do your blood work and any other relevant test during the prenatal period after discussion with you.
For couples planning home births the midwives will visit your home to become familiar with the location, to meet others who are expected to be present at the birth, and to answer any questions that anyone attending the birth may have. Your family and friends are welcome to attend clinic with you. If you are planning to have your children at your birth we suggest you bring them to meet us.
Labour And Birth ↑
For each client, we work in a team that includes two registered midwives, and a midwifery student. Our care throughout labour includes monitoring labour progress, maternal vital signs, fetal heart rate and position, providing perineal support, delivering the infant and placenta, suturing if required, examining the newborn, assessing involution of the uterus and maternal condition. Following the birth we help with breastfeeding, provide emotional support, and give information and guidance to the family. In situations where birth plans change, we continue to provide parents with information about their options and give support in making decisions.
Midwives attend women giving birth at home and the hospital. Our practice has privileges at North York General Hospital.
Postnatal Care ↑
After the birth we remain with the mother until we are reasonably certain that all is well with both mother and infant; usually 2 – 4 hours. Should any subsequent problems arise, we are always available by pager. Postnatal instructions are given to parents after the birth. After the birth your midwives will visit you at home usually on days one, three and five. Between days ten and fourteen we will see you again either at home or in the clinic depending on your particular circumstance. The last two visits are between three and four weeks and at six weeks postpartum. We provide vitamin K, erythromycin eye treatment, and PKU testing for newborns. If Rh immunoglobulin (Rhogam) is necessary we will notify you and make appropriate arrangements for its administration.
Prenatal Classes ↑
Classes are strongly recommended for all first time clients with their partners or other support person. We offer classes through our office, but can also give you information on other options in the community. Classes cover risk assessment, nutrition, normal labour and delivery, relaxation and breathing techniques, complications and emergencies, psychological concerns, postpartum issues, breastfeeding and early parenting. Classes are not covered by OHIP.
Parents Role And Responsibility ↑
We encourage our clients to be responsible for the health of both themselves and their babies. Following a balanced diet, participating in good prenatal care and getting adequate sleep and exercise are all helpful. We also request that parents acquire the knowledge and skills necessary for labour, birth, and early parenting either through prenatal classes or self-education. For women planning to breastfeed their babies we recommend attending a support group such as La Leche League in the last few months of your pregnancy.
If you are planning to have your children at your birth we recommend that you have another adult present to care for their needs. Obviously, this person should also feel comfortable with being present at your birth.
A midwife’s care is individualized for each particular client. It is important for you to make us aware of your expectations. In order to be effective as caregivers, we require that parents keep us well informed of problems or situations which may affect their care.
Risks And Place Of Birth ↑
There are distinct risks and benefits to any place of birth. It is the responsibility of parents to become as informed as possible, to weigh those risks and to make decisions appropriate for themselves. As midwives attending births at home, we believe planned homebirth is a safe option for healthy mothers with low risk pregnancies. Adequate prenatal care is the most important factor in detecting and avoiding possible complications.
Continued monitoring throughout the labour and birth process allows for assessment of possible complications and their appropriate management. Difficulties however, can arise during labour and birth most of which are not life threatening and can be dealt with at home or safely transported to hospital. There are some rare circumstances when the use of the technology available only in a hospital may be essential for the safety of mother and/or baby.
Choosing to give birth either at home or in the hospital means acceptance of certain risks which may be life threatening. A good consultation arrangement with physicians in hospital is essential for management of situations, which fall outside of normal. We can provide you with information about some of the complications, which may arise, and we encourage you to discuss with us our experience in dealing with them.
When To Page Your Midwife ↑
- Vaginal bleeding that is more than spotting and not after intercourse
- Severe abdominal pain, nausea or vomiting
- Severe headaches, dizziness or blurred vision
- A marked decrease in baby’s movement over 12 hours after 24 weeks of pregnancy
- Fever >38 degrees C or 100.4 degrees F
- Signs of preterm labor (before 37 weeks)
- Water breaks
- Hot, red area on calf
- Rhythmic, regular labour contractions
- Pain or burning when urinating
- Any urgent concerns about you or your baby
Client Records ↑
Your midwifery records are your property. You may have access to them at any time. At your six-week follow-up visit we will provide you with a copy of your records and will retain the original for our files.
The Ministry of Health Ontario Midwifery Programme as well as the agency which funds your care will need to gather information about who is using midwifery services. You will be asked to sign a release form to allow us to provide your name and health card number to these agencies.
We respect each client’s right to complete confidentiality. However, a large part of our work involves educating women and their families about pregnancy, birth and parenting. Our most useful tool in teaching is telling people’s stories and showing slides, videos or pictures. Please let us know if you want to keep all or part of your experience confidential. (Your records are confidential and will only be seen by your midwives and your doctor on request).
The Association of Ontario Midwives peer review provides a forum for the confidential discussion by practicing midwives of cases in which care may be controversial or of clinical interest.