Community Midwives of Halton
Informed Choice Agreement
This Informed Choice Agreement is provided to explain our philosophy, services,and education as midwives. We are regulated by the College of Midwives of Ontario under the Midwifery Act, which was proclaimed on December 31, 1993.Because of this Act, midwifery services are available and funded for Ontario residents.
We follow the regulations and standards for midwifery care as laid out by the
College of Midwives of Ontario, which includes screening for risks and consulting with other practitioners when necessary. These standards and our practice protocols are available in our clinic. We offer complete midwifery care during pregnancy, labour, birth and the postpartum period. Our care involves physical assessments, lab work, time to answer your questions, and discuss a number of topics such as:
- nutrition, exercise and lifestyle issues
- normal physical and emotional changes
- diagnostic procedures and medical interventions
- preparation for labour and birth
- abnormalities, complications and emergency measures
- infant care and breastfeeding
- postpartum adjustment and parenting
- fertility awareness and family planning
Pregnancy care includes regular visits, approximately once a month for the first 28 weeks, then every 2-3 weeks until 36 weeks, then weekly until birth. Visits generally last 15-30 minutes. We encourage both partners to be present, and welcome other family members.
During active labour we are in attendance to provide clinical care, reassurance,and an extra pair of comforting hands. After the birth, we stay until confident that the mother and baby are stable and adjusting well, usually a few hours.
Postpartum care includes four visits within the first ten days, and then clinic visits every one to three weeks until six weeks postpartum. More appointments are made if needed. The comprehensive care we give allows clients who give birth in the hospital to choose whether to stay overnight or head home after a few hours to recover in the comfort of their own home.
Midwives are primary caregivers and it is unnecessary for you or your baby to see a physician for additional obstetric or newborn care. Any concerns relating to pregnancy and postpartum should be directed to the midwife. We will refer any medical concerns relating to the pregnancy, birth, or postpartum to the appropriate specialist. If care must be transferred to another care provider in our community, we normally continue to provide support. In the case of non-pregnancy related concerns, we will refer you to your family doctor or another health care provider as appropriate.
Our practice uses a paging service for clients to contact their midwives for any urgent concerns that may arise during care. Examples of reasons to page include onset of active labour, waters breaking, not feeling the baby moving, a fall or car accident, severe nausea and vomiting, preterm labour, severe headache, or fever/feeling unwell. When you page, ask the dispatcher for your Team (assigned at your first appointment) and be specific about the reason for calling. Please do not call Telehealth regarding pregnancy concerns. All other non-urgent concerns should be directed to our office via email or call where staff will relay them to your midwives. You should get a response to non-urgent concerns within 24-48 hrs if a message is left during office hours.
You are welcome to use our lending library, consisting of books and DVDs. During the course of your care we may recommend various reading materials that are relevant to your needs. We encourage all clients to prepare for pregnancy, birth and the postpartum as much as each individual can. A variety of prenatal classes are available in our area, and are particularly helpful for first time parents.
Midwifery care is covered by OHIP for residents of Ontario. Ontario midwives are paid on a “per client” basis on contract with a Transfer Payment Agency of Ontario’s Ministry of Health and Long Term Care. This means midwives are paid for complete care as a package, not separately for each visit as in “fee for service”. You can only see one care provider for the same care in pregnancy; duplicating services may jeopardize the payment to one or both care providers and is an abuse of health care dollars. This is different from requiring a consult with an OB because of complications in pregnancy, which we will arrange in consultation with you should the need arise.
Non-residents who are visiting the province can apply for care and pay privately for services, if there are spots available when they are due.
We are a teaching practice, affiliated with the Midwifery Education Program at McMaster, University. Over the course of your care, a student may participate in discussions and provide hands on clinical care. The students provide more and more care in the role of the primary caregiver,according to their level of experience and ability as they progress through the education program. In their final clerkship course, the students provide care in the role of a primary midwife. In order to preserve continuity of care and provide the opportunity for students and clients to establish a relationship, we normally assign each student to follow specific clients. Students are here for varying lengths of time, so you may meet a student either early or late in your pregnancy.If you are concerned about having a student or about the care they are providing,please speak to your midwife as soon as possible. For more information regarding courses and student roles ask us.
Availability and Shared Call Teams
We practice shared care in our group, in which each client is assigned a team of two to three midwives. One of the midwives will be your coordinating midwife who will oversee your care, but your visits will be shared within the team. Your appointments will alternate between the midwives so that by the end of your pregnancy you will know them all well. When you are in labour one of the midwives on your team will attend, and call a second midwife (who you may or may not know) when the birth is near. Midwives in these small teams will alternate time off over the course of your pregnancy, but they would not all be scheduled off close to your due date. On rare but unavoidable occasions, such as either simultaneous births, having your baby preterm, or an illness, you may have a midwife you have not met before or only seen at the clinic. Although our personalities are different, we all hold the same beliefs and practice to the same standards, and would work with you to make your experience a positive one.There is always a midwife available 24 hours a day, 7 days a week for urgent concerns. This call model minimizes the need to cancel and/or reschedule clinic appointments as midwives are generally off call during clinic days.
Midwives tailor the care they give to the individual client, so it’s important for you to tell us your expectations, and to keep us informed of any situations that could affect your care. It is your responsibility to ask questions and make final decisions about your care and that of your baby. Our role is to help you access the information you need to make those decisions.
Clients are responsible for their health and that of their babies, which includes paying attention to diet, rest, exercise and regular prenatal care. During pregnancy we request that you learn about the process of pregnancy, labour and birth, relaxation techniques, postpartum adjustment, infant care and breastfeeding. Prenatal classes, La Leche League meetings, and readings are recommended.
When to cancel an appointment
In order to prevent the spread of infection, please do not come into the office or bring in small children or partners if you/they have been diagnosed with any contagious disease, or have been running a fever, flu-like symptoms, coughing, vomiting and/or diarrhea within the last 24 hrs. We will be happy to reschedule your appointment to a time when you/they are feeling better and are not contagious to other clients and their infants. If you are feeling very unwell with any of the above symptoms, page your Team.
Perfumes and Lotions
Scented products can cause allergic reactions in an enclosed space. Pregnant clients are often hypersensitive to smells and some of our staff and midwives become ill when exposed to scented products. We ask that you please do not wear any scented products when you have a midwifery appointment.
Birth is a natural biological process, that often unfolds with minimal assistance. Whether you choose to give birth at home or in hospital is up to you, our role is to inform and support you in order to have a positive and safe birth experience. There are times when we will recommend one option over the other given your specific pregnancy history. There are distinct benefits and risks to each place of birth, and we encourage you to discuss this with your midwives. In order to have the best experience, you need to feel safe when you are in labour, and that means different things to each individual.
Based on Canadian and international research findings, we support the choice of planned home birth as a safe option for healthy clients with low-risk pregnancies. Planned home birth has been shown to reduce the need for obstetrical interventions (use of oxytocin, epidural, vacuum/forceps and cesarean section) as well as reduced rates of infection for mothers and babies. Clients who choose home birth often wish to have more control over their birth environment (a more intimate experience), may be interested in water birth, wish to avoid traveling in active labour, and want to avoid unnecessary intervention. More information about home birth is available by asking your midwives and/or attending our home birth information nights offered once a month.
Hospital birth is the other option for clients. It is the most frequently chosen option. The most common reasons clients choose hospital is for access to epidurals and in the event of complications that assistance is on site. By coming to the hospital in active labour, should any problems arise or pain relief is requested, clients do not have to change locations. The availability of assistance or epidurals is not always immediate and is hospital location-dependent, meaning not all obstetricians, anaesthesiologists, or pediatricians stay on site when on call. Hospitals also have policies and procedures about which you may have to make compromises to your birth plan, which can be discussed during visits. If you and your baby are well after birth, you have the option of early discharge from the birthing suite. If you choose to leave early, a midwife will come visit you and your baby at home within 24 hrs, and provide testing for the baby normally done in hospital.
We will help you explore the available options, including the benefits and risks, and provide the same care regardless of setting. Feel free to discuss this further with us at any time. We hold active privileges at OTMH and MDH. Please refer to the “Having Your Baby” online resource booklet for more information about the hospitals.
Confidentiality and Communication
All professional communication with clients is kept confidential. Specific information regarding your situation is shared with professional colleagues who are providing you with care. You are free to examine your chart at any time.
Your privacy is important to us. Our practice utilizes an EMR (electronic medical record) and follows Ontario privacy legislation standards. Each client is given a unique client code that is used for internal communication to avoid use of full names and health card numbers.
Communication with you between office visits is primarily through phone calls, emails and occasionally text messages. Please make sure we have your correct phone number, home address and email address on file. Many midwives have blocked numbers so if you page or are expecting a call, please pick up. Regarding regular office emails (versus our intake form) and texts, note that these methods of communicating are NOT encrypted so be aware anything you choose to send to us may be accessible to hackers.
I have read the Informed Choice Agreement and agree to its terms: