Answering Your Questions
Here are some frequently asked questions about Midwifery and Family First Midwifery & Wellness and the birthing process. If you still have something you’d like to know, feel free to contact me for more details.
WHAT DOES A MIDWIFE DO?
In a nutshell, midwives are specialists in healthy pregnancy and birth. Registered midwives in BC have similar scopes to family physicians who offer maternity care services, but specific only to maternity. Registered Midwives in BC offer primary maternity care to healthy pregnant women and their newborn babies from early pregnancy, through labour and birth, until about six weeks postpartum. What does this really mean? Midwives listen, observe, educate, guide, and care. They order and interpret tests, discuss results and collaborate with physician specialists to make care plans as needed. They screen for physical, psychological, emotional and social health. They are with women during pregnancy, labour and birth, normal and complicated. They catch babies. They prescribe pain medication in labour and can consult for an epidural as needed. They can assist with C-sections and order induction of labour medications when certified to do so. They do home visits postpartum. They help with breastfeeding and adjusting to life with a new baby. Midwives, when certified, can also prescribe hormonal contraceptives and place IUD's. They work together and side by side with other healthcare professionals. They practice evidence-based, patient-centered maternity and newborn care and are an established part of the BC health care system.
IS MIDWIFERY CARE SAFE?
Midwifery care is a safe choice for low-risk, healthy women. It is endorsed by many organizations that strongly influence maternity care in our country, including the Society of Obstetricians and Gynecologists of Canada (SOGC). Women and babies actually tend to fare better in countries where midwifery care is the norm. Midwifery clients experience lower rates of forcep and vacuum deliveries, cesarean sections, episiotomies, infections, and babies requiring resuscitation, when compared with women in the same risk group delivering with physician-led care. Midwives are registered with and regulated by the British Columbia College of Nurses and Midwives according to the BC Health Professions Act, the Midwives Regulation, and the CMBC Bylaws. Midwives have been regulated and legally recognized as autonomous healthcare practitioners in BC since 1998.
IS THE COST OF MIDWIFERY CARE COVERED IN BC?
BC Ministry of Health funding covers the cost of midwifery care for all BC residents with a valid Care Card through the BC Medical Services Plan, including the basic costs for homebirth supplies. It is important to note that coverage is provided for only one type of health care provider for healthy pregnancies in BC. See "Can I have a doctor and a midwife?" below.
I AM NOT COVERED BY THE BC PROVINCIAL HEALTHCARE PLAN. CAN I STILL HAVE A MIDWIFE?
Yes. Your first step is to make contact with a midwifery clinic and discuss with them the option of paying for your care privately. However, their costs do not include supplies, laboratory tests and blood work, ultrasound scans, or any hospital or physician charges including the costs associated with hospital births. Private Pay patients will be required to make arrangements to make a financial deposit with the local hospital prior to delivery.
WILL I HAVE ACCESS TO THE SAME TESTS AND PRESCRIPTIONS THAT I WOULD HAVE HAD WITH A DOCTOR?
Midwives offer a complete panel of prenatal laboratory tests, genetic screening and diagnosis options, ultrasound imaging and many other tests and procedures for women and newborns. A midwife's scope of practice includes the use of many medications that may be indicated in pregnancy, during birth including emergency situations or pain medication, and for mom or baby postpartum. If medication or testing is required outside of this scope of practice, midwives consult with and refer to physicians as indicated for more specialized care.
WHAT ARE MY PAIN MANAGEMENT OPTIONS?
It is impossible to predict how your birth journey will unfold and there are times when an intervention can become a helpful and necessary tool. This includes the use of medications, and in some cases, epidurals. It is important that you feel supported, listened to, and feel a sense of achievement after your birth. Midwives can prescribe and order the same pain medications for labour that a physician can, including narcotic pain management and epidurals. We will discuss your options prenatally with you, including all methods of coping in labour in the event that medically managed pain is requested.
CAN I CHOOSE WHERE I GIVE BIRTH, AT HOME OR IN A HOSPITAL?
Many midwives, including the midwife at Family First Midwifery, have admitting privileges in hospital, just as a family doctor or obstetrician would. We can admit patients and provide care in the hospital. We believe that choice of birthplace is an important aspect of your maternity care and strive to provide you with options. Midwives also support women and families choosing to give birth at home or at the local, private pay Birth Suite at Maternity Tree
CAN I HAVE A DOCTOR AND A MIDWIFE?
The BC Medical Services Plan covers only one primary care provider for the duration of your pregnancy and birth, to six weeks postpartum for healthy pregnancies with the exception of when an obstetrician needs to be involved. The choice of caregiver during your pregnancy is up to you. Midwives are specialists in healthy pregnancy and normal birth and consult with family physicians and other specialists such as obstetricians as the need arises. At six weeks postpartum, when your midwifery care is completed, you will be transferred back to your family physician who will resume responsibility for the health of you and your new baby. Families who do not have a family doctor are responsible for making arrangements for their ongoing primary care. Your midwife can provide you with more information on finding a physician for your family.
DO I NEED A REFERRAL TO SEE A MIDWIFE?
No referral is required. Simply look up the contact details of your local midwifery practices and give them a call. Find a midwife in your area by using the Searchable Map found on the Midwives Association of British Columbia website.
WHEN SHOULD I CONTACT A MIDWIFE TO SCHEDULE MY FIRST APPOINTMENT?
Contact a midwife as soon as you know you are pregnant. As the first step in seeking care, Family First Midwifery has an Online Intake Form (no obligation to you) for you to complete. This information will help us better assess your particular needs and determine if we can be of assistance to you. Midwifery practices may become full quickly depending on the community and practice volume. However, if you are put on our waitlist, you can call or email at any time to check if any spaces have become available.
HOW OFTEN DO I SEE MY MIDWIFE?
Midwife visits happen about as often as visits with physicians in pregnancy. Most visits in the first part of pregnancy are scheduled every three to six weeks and last between 30-60 minutes. In the third trimester visits are scheduled more frequently and are often every week during the last month of pregnancy. Longer visits allow for physical, emotional and social health assessments and allow time for informed decision making and the development of a trusting relationship between women and their care providers. These factors allow us to tailor your care to your specific needs. Postpartum visits usually take place wherever the new family is. This may be in the hospital initially after a hospital birth, and then in the new family's home once they have returned, or at home after a home birth. After the first week or two, visits usually happen back in the clinic and continue to about six weeks postpartum when your care is transferred back to your family physician. Between visits, midwives provide 24/7 call coverage for urgent care or concerns.
HOW MANY MIDWIVES WILL BE INVOLVED IN MY CARE?
Generally speaking, midwives often work in groups of two or three, but may also work as solo providers. Some work in interdisciplinary models with other care providers such as physicians or nurses. 24/7 call coverage will always be offered. In small group practices most clients will have met all of the midwives in the group by the time labour begins. The CMBC Model of Midwifery Practice document highlights the concept of continuity of care in providing safe, individualized care. At Family First Midwifery there will be a solo practitioner providing you with care. Occasionally midwives from other local practices will be involved in your care in order to provide back up/relief to your midwife, or coverage for time off.
WHO WOULD BE AT MY BIRTH?
It is your choice who to have at your birth. Your support team is very individual to you. This may include children and other family members. This may include friends. The choice is yours and will be discussed at your prenatal visits. Children and other family members may require some special preparation.
Two care providers will always be with you at the time of delivery of your birth. In the hospital a Midwife and Registered Nurse will be part of your birth. If you are planning a homebirth, you will have either two midwives, or a midwife and a Registered Nurse (RN), if a second midwife is unavailable. They usually arrive late in active labour and stay for a couple hours after the birth with your Midwife.
We believe that it is extremely important to foster the future of the midwifery profession. We may have midwifery students that are practicing with as at various stages of their education. Most of the time, you will have met a student and will have a sense of what they may be responsible for at your birth. The primary midwife will always be present with a student. Please feel free to ask our students or ask your midwives if you have any questions or concerns.
I AM MORE THAN HALFWAY THROUGH MY PREGNANCY AND I HAVE BEEN IN THE CARE OF MY FAMILY DOCTOR UNTIL NOW. CAN I TRANSFER TO A MIDWIFE, OR IS IT TOO LATE?
Yes, it is possible to transfer care at any time in pregnancy, however with the high demand for midwives, it may be difficult to find an available practice.
AM I TOO YOUNG OR TOO OLD TO HAVE A MIDWIFE?
There are no age restrictions on midwifery clients.
COULD COMPLICATIONS RULE OUT MIDWIFERY CARE?
Generally speaking yes, this is possible depending on your personal circumstances. However, if you do not qualify for Primary Midwifery Care, you can still receive Supportive Midwifery Care for your pregnancy, birth and postpartum to 6 weeks. During your initial visit, the midwives should be able to give you an idea of whether or not the care you need is covered by their scope of practice. Should complications arise while in a midwife's care at any time, the College of Midwives of BC's guideline will help inform the decision to consult with or transfer care to the appropriate physician or specialist.
WHAT HAPPENS IF THERE IS A TRANSFER OF CARE?
Transfers of care usually arise with more urgent scenarios. Even when the complication arises early in pregnancy, midwives usually remain involved in a supportive role, with care sometimes transferred back once the complication has resolved. More common are consultations with specialist physicians such as obstetricians or pediatricians. In these cases midwives remain involved in the care provided. For details on why a consult may be initiated, see the CMBC document on Discussion, Consultation, and Transfer of Care.
WHAT HAPPENS IF I HAVE TO HAVE A CESAREAN SECTION?
Choosing a midwife as your primary care provider in BC lowers your chance of having a Cesarean section. However, in certain circumstances a cesarean birth may be recommended as a safer option than vaginal birth. In most situations midwives are involved in the decision making process whether in labour or prenatally, and will be present during Cesarean births and for healthy baby care afterwards. Women remain in the hospital longer after a Cesarean section birth, therefore midwives visit women and their babies in hospital until they have returned home. Click here to read more about birth by C-section. Click here for recommendations from the recent "Cesarean Birth in BC" conference.
WHAT IF I WANT TO HAVE A BOOKED CESAREAN SECTION?
Women choosing to have a booked Cesarean Section can still have a midwife for their prenatal and postpartum care. As well, Midwives can assist the Obstetrician with your Cesarean Section and provide support throughout the process.
WHAT IF I HAVE A HEALTH ISSUE UNRELATED TO PREGNANCY?
Women continue to see their family physician, or other specialist physician, for health issues unrelated to pregnancy.
WHAT IS THE WORKING RELATIONSHIP BETWEEN MIDWIVES AND OBSTETRICIANS?
Midwives consult with family doctors, obstetricians, pediatricians, and other specialists as the need arises. These relationships are collegial and collaborative in nature. We work together as a team in order to provide the best care for you and your new baby. The CMBC guideline lists reasons for discussion, consultation, and transfer to a physician or other specialist. Individual hospitals also often have policies on when consultation or transfer may take place.
WHAT’S THE DIFFERENCE BETWEEN A MIDWIFE AND A DOULA?
Midwives and doulas play different, yet complementary roles in your labour and birth. Doulas provide prenatal, labour, and sometimes postpartum emotional and physical support. Doulas do not provide care in a medical or clinical arena, whereas Midwives are trained and registered to manage the clinical aspects of your pregnancy, labour, birth and postpartum for you and your baby. Doulas do not deliver babies, and are not responsible for ensuring the clinical health and well-being of the mother and newborn. Midwives are trained and licensed to be responsible for and manage all of these clinical needs just as a physician would. Doulas work as part of your team, along with a midwife or physician. They provide constant emotional support and are there for the duration of labour, including early labour where your midwife will not constatntly be directly present. Doulas are for partners too and they are a very welcome resource at any birth.
WHAT’S MY ROLE AS A MIDWIFERY CLIENT?
Your role as a client is to learn! Pregnancy and childbirth offers us many things, and the opportunity to grow a solid understanding of your body is just the beginning. For many women (and their partners), pregnancy is their first entry into learning about health and wellness. We offer diet counseling and discuss ways to maintain your health so that you have a healthy, low-risk pregnancy, birth, and postpartum period. Please ensure that you bring questions with you to your prenatal appointments so that we can be sure to provide you with comprehensive care. Informed choice is a big part of your care, so you want to make sure that you are reading and ‘doing your homework’ so as to make the best decisions for yourself and your baby. We can guide you along the way, but the work is yours!
If you do not see your question answered here, please check our Resources page or email us for more information.
(With warm thanks to the Midwives Association of British Columbia)