Midwives are healthcare practitioners who specialize in normal pregnancy, childbirth and post-partum. Midwifery is now regulated in many Canadian provinces (including British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, Northwest Territories and Nunavut, with legislation pending in some of the Atlantic Provinces).
In Canada, though all are known as midwives, we have nurse-midwives, direct-entry midwives and lay midwives. Nurse-midwives are former nurses who took additional training to become midwives. Direct-entry midwives have trained in a clinical setting (midwifery school or university) specifically to become midwives without first training to be a nurse. Lay-midwives trained as apprentices or through self-study, do not have formal clinical training and are un-licensed or un-certified.
Midwives treat birth as a normal physiological event which does not require managing and which proceeds best when intervened with as little as possible. Midwives are trained to spot and mitigate problems and complications in the pregnancy and birth. They may work in conjunction with other practitioners including physicians and obstetricians should the need arise and in some cases may need to transfer care if serious complications develop.
Midwives believe that the mother should be an active participant and decision-maker in her care. Midwives are entitled to hospital privileges, can prescribe medications and standard tests and offer choice of birth place (home, hospital or birth center depending on the province).
In most cases your appointments with your midwife will run about 50 minutes as opposed to the standard 10 minutes with a doctor. This means that your midwife has more time to explain procedures and tests to you so that you can truly give informed consent (if you choose to). It also means that you get to know your birth team a little better and therefore, may feel more comfortable voicing any concerns you may have.
In the first two trimesters, appointments are once a month and increase to about once a week near the end of the third trimester. Many midwives also offer a few home visits during the first two to three weeks postpartum where they monitor the baby’s health, your recovery and the initiation of breastfeeding.
A typical appointment will include explanation of upcoming procedures and tests and your right to waive any of these that you are not comfortable with or that you deem unnecessary, opportunity for you to ask questions and voice concerns, a routine physical exam that includes measurement of your belly from top of the uterus (fundus), testing your urine, listening to the baby’s heartbeat, taking your blood pressure and occasionally checking your weight. Your first appointment will also include a full medical history.
Midwives often work in teams of two or three. This means that you will alternate clinic visits between your midwife team so that you have ample opportunities to get to know them. One of them will be on call at all times so that you can access care whenever you need it. As well, they alternate call and you can expect that one of them will be at your birth. Two midwives attend a home birth (one for mom and one for baby) but typically one will attend a hospital birth and be assisted by the hospital nurse.
Please visit the site for your province to find a midwife near you:
Alberta Association of Midwives (AAM)
Midwives Association of British Colombia (MABC)
College of Midwives of Manitoba
Midwives Association of New Brunswick
Association of Midwives of Newfoundland and Labrador Midwives
Association of Ontario Midwives (AOM)
Regroupement des sages-femmes du Quebec (RSFQ)