Autonomous, Community-Based Primary Care

Midwives are primary care providers in autonomous practice, with hospital privileges within their communities. For each client, under their own responsibility, the midwife provides a continuum of midwifery services throughout pregnancy, labour and the postpartum period. Midwives practice in a range of settings, including clinics, clients’ homes, hospitals, and other community-based settings. Midwifery care for labour, birth and early postpartum is provided in a setting chosen by the client and appropriate to their level of risk. In all settings, midwives remain responsible and accountable for the care they provide.

Evidence-Based Care

Midwives’ fundamental accountability is to the clients in their care. They are also accountable to their peers, their regulatory body, the health agencies where they practice and the public to for the provision of safe, competent, ethical practice informed by the CMBC Philosophy of Care and current evidence in perinatal care. Midwives develop and share midwifery knowledge, promoting and participating in research.

That means current research guides our care and benefits those who come to us. If we discuss aspects of your care and give recommendations, it’s because this is what the current evidence indicates. We do reviews with other midwives and primary care providers to share knowledge and stay up to date with community standards of practice.

There is a lot of information out there and it can be difficult to determine the source. We will review information with you to ensure your decisions are being informed from reliable, research-based evidence.

Informed Choice

Informed choice is a collaborative exchange of information between a midwife and a client that supports decision making in clinical care. It is a fundamental principle of midwifery care in British Columbia. We believe that YOU are the best decision-maker for your pregnancy, birth and beyond. What we do is present you with the most current balanced and relevant evidence-based information on anything, from tests offered during your pregnancy, to choice of birth place, to medications routinely offered to you and your baby at the delivery.

Some of the information involved in informed choice discussions include:

  • what is being proposed/offered and its risks/benefits;

  • any alternatives to what is being proposed/offered and their risks/benefits;

  • what would happen if no treatment/procedure/test/medication is chosen;

  • relevant research evidence including any deficiency of clear evidence;

  • relevant community standards of care and practices;

  • considerations according to the CMBC’s Indications for Discussion, Consultation and Transfer of Care

  • the Registrant’s recommendation for the client, supported by evidence, CMBC standards and community standards.

You can read more on the CMBC’s Policy on Informed Choice here.

 

Choice of Birth Place

Many people believe you have to have a home birth if you choose a midwife as your care provider. This is in face a common misperception. Midwives have the unique position of being able to offer births in both home and hospital setting, while remaining your primary care provider in either place. We do the majority of births in a hospital setting because this is the most common choice, but we are equipped and skilled to do home births and they are becoming a common choice.

The Society of Obstetricians and Gynecologists released a statement on home birth in 2019 in which they state “ In Canada, planning a home birth with a registered midwife or an appropriately trained physician in the integrated system described is a reasonable choice for persons with low degree of risk where the birth is anticipated to be uncomplicated and neither mother nor neonate will require resources beyond the local capacity.” You can read the entire SOGC Statement on Home Birth here.

Some benefits of home birth include:

  • just as safe as hospital births when attended by a trained and licensed midwife for low risk women (this is an evidence-based statement)

  • decreased likelihood of interventions in labour

  • decreased use of pain medication in labour

  • more control over the environment

  • more comfort being in one’s home

Many people enjoy their hospital births and we love doing them just as much because we have such incredible working relationships with hospital staff and the other care providers who might be required at the birth.

We believe families are the best decision-makers for where they would like to give birth. It’s our job to ensure you make an informed choice and where you are planning to deliver.