Midwifery in Ontario

What is a midwife?

Midwife means "with woman". To midwives and their clients, pregnancy and birth are normal, healthy life events. Midwifery promotes normal childbirth and the prevention of health problems. In 1994, midwifery became an integrated part of the Ontario healthcare system and is provided free of charge to residents of the province. Midwives offer clients the option of delivering at hospital, home or one of two birth centres (Toronto and Ottawa).

A midwife is a primary care provider who is responsible for all the care necessary for a healthy expectant person and the baby throughout pregnancy, birth and for six weeks afterward. Midwives refer clients and newborns to family doctors or specialist doctors like obstetricians and pediatricians if the care becomes complicated. Even if care is transferred to a doctor at the birth, midwives will remain involved in the care as a support to the client and baby.

As primary care providers, midwives do the following:

• care for healthy, pregnant persons and their babies;
• see clients for all prenatal visits and give prenatal education;
• order laboratory and ultrasound testing if needed;
• arrange for consultations with or transfers to doctors if needed;
• give some medications during pregnancy, labour, birth and the postpartum (after birth) period if needed;
• take responsibility for primary care during labour, birth and postpartum including delivering the baby;
• examine the newborn and care for clients and babies for six weeks after the birth.

You do not need a referral from a physician to use midwifery services; you can call a midwife directly. However, it is best to call as early in pregnancy as possible to ensure that your midwife has space for you.

There are currently more than 900 midwives registered with the College of Midwives of Ontario.

What are the principles of midwifery care?

There are three important principles of midwifery care:

Continuity of Care

Midwives usually work in small groups and are on 24-hour call. A pregnant client will get to know a small group of midwives (2-4) to ensure that the client is comfortable and familiar with the caregivers who will attend the birth. Generally, two midwives will attend each birth and share the care throughout the pregnancy, labour, birth and after the birth for six weeks. They will offer education, counselling, advocacy and emotional support. Each midwife will take the time to build a relationship of trust and safety with each client. If medical problems develop during pregnancy, labour, birth or postpartum, midwives work closely with specialist physicians and nursing staff.

Informed Choice

Midwives encourage each client to take an active part in care throughout pregnancy and birth and will provide information so that the client can make choices about care. Midwives provide sufficient time during prenatal care to discuss questions about important issues like nutrition, birth plans, breastfeeding and parenting. Midwives recognize and support the client as the main decision-maker.

Choice of Birthplace

The pregnant client chooses whether to give birth in a hospital, at one of Ontario’s two birth centres in Ottawa or Toronto, or at home under the primary care of the midwife. Midwives are trained to attend births in these places as well as to help individual clients choose the safest place for them. Many clients who opt to have a hospital birth spend time at home with their midwife before going to hospital.

Midwives’ training prepares them to be responsible for decisions about labour, delivery, postpartum and newborn care both at home or in hospital. Midwives work closely with other community midwives, doctors and nurses to maintain a high standard of care.

• Toronto Birth Centre
• Ottawa Birth and Wellness Centre