The Ontario Hospital Association (OHA) has published an updated reference guide to help midwives, doctors and nurses work together to deliver patient care.
Released in September, the Resource Manual for Sustaining Quality Midwifery Services in Hospitals was updated in response to a recommendation from a coroner's inquest into the death of newborn Eoin Stalker in May 2000.
The coroner ruled that the child's death was not linked to conflict between the midwife and the obstetrician on call, Dr. Nabil Namis, at Guelph General Hospital, but the jury nevertheless called for better integration of midwives into the hospital setting and the removal of barriers to effective care.
"The manual can help maternity care teams improve and sustain positive working relationships, which will promote safer, high-quality care," said OHA president and CEO Tom Closson.
"Mothers and their newborns will definitely benefit from having more, and better interprofessional collaboration among their caregivers. That's why the OHA supports integrating midwives into Ontario's hospitals and believes that midwives are an important part of the maternity care system alongside their physician and nurse colleagues."
Barriers
Despite being regulated as a health-care profession in Ontario for 17 years, "midwives continue to face some barriers in terms of accessing hospital privileges and working to their full scope of practice in hospitals," noted Katrina Kilroy, president of the Association of Ontario Midwives.
"I participated in a project funded by HealthForceOntario to go into hospitals around the province with interdisciplinary teams to look at the interprofessional relations within the birthing unit and one thing that was very clear was that we don't have as broad-based an understanding of how each other works as we should," said Kilroy.
The opportunity for improved interprofessional relations also applies to some locations in Northern Ontario, said Barbara Kemeny, a registered midwife and member of the Maternity Care Midwives practice in Thunder Bay.
Mixed reception
"We initially had a mixed reception in Thunder Bay," said Kemeny. "There were some people who were very, very supportive, but there were also some people who would never return our phone calls."
With the passage of time, "we were able to deal with our issues and I must say I'm very happy to be working in Thunder Bay because there are some locations that are not as conducive to interprofessional relations and safe care."
Thunder Bay is served by two midwifery practices. Maternity Care Midwives is staffed by four full-time practitioners and operates out of the Thunder Bay Maternity Centre, while a second practice, Community Care Midwives, has seven part-time practitioners.
Northern Ontario is also served by midwifery practices in Kenora, Hearst, Sault Ste. Marie, Timmins, Manitoulin Island, Sudbury and North Bay.
Kemeny was trained as a midwife in Germany and settled in Thunder Bay in 1976 – years before midwifery was recognized as a profession in Ontario.
"As soon as women in the community got wind of the fact that there was a midwife in town, I started getting phone calls," she said.
Kemeny delivered her first baby in 1977 – a girl – and years later attended the birth of her two children as well.
"The legalization of midwifery was basically an initiative of midwives and mothers who lobbied the government very heavily, and also because of some mishaps that happened at home when midwives had no access to the health-care system," she said.
There are currently 500 registered midwives practicing in Ontario in approximately 70 clinics around the province. Since 1994, more than 100,000 babies have been born under midwifery care, including more than 23,000 home births.
Thousands turned away
Midwives attend only 10 per cent of births in Ontario, but turn away thousands seeking their services.
"Forty per cent of women who request midwifery care can't get it," said Kilroy. "In my practice in downtown Toronto, we turn away about three times as many people as we can accommodate."
It's a different story in Thunder Bay, which has 11 midwives in two thriving practices who attend approximately 25 per cent of births in the city.
"Tracking across the province shows that midwives have excellent outcomes," said Kilroy. "The clinical benefits are pretty clear. Midwives have extremely high breastfeeding rates for their clients. That's not a surprise because we do visits in women's homes and we do at least three post partum visits in the week following childbirth. We also know that midwives have significantly lower rates of interventions when compared to low risk clients generally. That includes C-sections, induction of labour, epidural use and instrumental delivery."
Laurentian University, Ryerson and McMaster offer the required four-year midwifery program and have a combined intake of 90 students per year.
Midwifery care is paid for by the Ministry of Health and Long-Term Care and is free to clients.
www.aom.on.ca
www.mcmidwives.ca.
