Info on Midwifery

What is Midwifery:
In BC, you can choose to have either a midwife or physician as your primary maternity care provider. No referral is needed.
- Midwifery has been a designated health profession under the Health Professions Act since 1995. Midwifery care is completely covered by the Medical Services Plan of BC, so there are no extra expenses to the patient. Our regulatory body is the College of Nurses and Midwives of British Columbia (link to website.)
- We have hospital privileges and can attend deliveries at West Coast General.
- We can order lab tests and ultrasounds and prescribe most medications that are likely to be needed during pregnancy .
- We consult and refer to medical doctors if there is a need for medical care beyond our scope. If consultative care from a physician is required, your midwives will continue to be a part of your care team as appropriate for the specific situation.
- We can offer home birth to those without complications or risk factors in their pregnancy, subject to availability of a qualified second attendant and the ability to safely move to the hospital if a higher level of care becomes necessary before, during, or after the birth.
- We offer home visits during the 1st week post partum or as needed.
- We support your right to make informed decisions about your care. We are educated and experienced in maternity care and we will share all the relevant information to help our patients decide what options are best for them. While we cannot guarantee everyone the birth they desire, we do strive for our patients to have dignity and empowerment in their care with us.
- For people who are hoping for a home birth, we ask that you read below on home birth and learn about how home birth works in our community.

Home birth and the current situation:
There is more than sufficient evidence that home birth with Registered Midwives is a safe and reasonable choice for people experiencing a healthy pregnancy. One of the major reasons for the excellent outcomes over more than 25 years of well-integrated home birth in BC is that midwives are a part of the larger healthcare system, which means that moving from home to hospital should it become necessary is as seamless as possible. It is important to understand that planning a home birth is never a guarantee of a home birth. Sometimes in the course of your pregnancy, during labour, or immediately after birth, complications can arise which mean that your health and safety or that of your newborn would be better supported in a hospital setting. In this situation your midwives will advise either a change in planned birthplace or a transfer from home to the hospital.

Sometimes home birth cannot be offered safely, not because of your personal health and safety needs, but because of a lack of system capacity. The standard of care for home birth requires both a Registered Midwife and a qualified second attendant to be in attendance during the second stage of labour and the first hours after birth. The second attendant could be another midwife, a nurse, or another healthcare provider who is qualified in neonatal resuscitation and CPR. In the event that none of our possible second attendants is available at the time of your labour, we ask you to understand that we will not be able to safely offer home birth.

We also cannot safely offer home birth if our local hospital is on diversion for maternity care, as this means the hospital does not have all of the necessary staff to effectively provide care for you or your baby if an emergency were to arise during your home birth. Presently, our health care system is under significant strain. On occasion, Sora and Sarah are on call for neonatal resuscitation at the hospital when there is not a Pediatrician or GP on call for that role. Because we cannot be in two places at the same time, we cannot commit to attending a home birth if the on-call midwife is also the hospital neonatal resuscitation provider. Having a qualified provider in this role is necessary to maintain the hospital maternity service, and we do not have the ability to immediately respond to a neonatal resuscitation emergency in hospital if we are attending a home birth.

We appreciate the deep disappointment this causes our families who planned for a home birth on the infrequent days we must cover at the hospital, or if no second attendant is available. Please come to us with your questions and comments regarding this topic. It is a less than ideal situation we find ourselves in.

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