What is a Midwife?
In a nutshell, midwives are experts in healthy pregnancy and birth.
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 and discuss results. 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 do home visits postpartum. They help with breastfeeding and adjusting to life with a new baby. They work together and with other health professionals. They practice evidence-based, woman-centered maternity and newborn care and are an established part of the BC health care system.
Midwives are registered with and regulated by the College of Midwives of British Columbia according to the BC Health Professions Act, the Midwives Regulation, and the CMBC Bylaws. Midwives have been regulated and legally recognized as autonomous health care practitioners in BC 1998.
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. 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.
In many cases, yes. Your first step is to make contact with a midwifery clinic and discuss with them the option of paying for your care privately. Midwives cannot charge you more than they bill the government, however that cost does not include supplies, laboratory tests and blood work, ultrasound scans, or any hospital or physician charges including the costs associated with hospital births.
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. The choice of caregiver during your pregnancy is up to you. Midwives are experts 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.
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 our Searchable Map.
Contact a midwife as soon as you know you are pregnant. Midwifery practices may become full quickly depending on the community and practice volume, however you can call at any time as spaces may become available or a practice may not be full for any given month.
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. 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.
Midwives often work in groups of two or three, but may also work as solo providers or 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.
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.
Midwives offer the choice of birthplace to healthy, low risk women based on the principles of informed decision making. On average, 70% of births attended by midwives occur in hospitals. This number varies by practice and community. For more information on home birth in BC read the CMBC Home Birth Handbook for Clients. You can read a large study on homebirth in British Columbia , literature as complied by the American College of Nurse Midwives or also An annotated guide to the available home birth , literature as compiled by the Division of Midwifery, UBC.
Midwives offer a range of natural and pharmaceutical pain relief options, including access to epidurals. It is paramount in midwifery care that women have access to the information necessary to make informed decisions about the use of pain relief options. These options are discussed during prenatal visits as well as during prenatal classes should you choose to attend classes in your community.
I'm more than half way 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.
There are no age restrictions on midwifery clients.
This is possible depending on your personal circumstances. 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.
Transfers of care usually arise with more urgent scenarios. Unless the complication arises early in pregnancy midwives often 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 nearly always 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.
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 usually 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.
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. 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.
Midwives consult with family doctors, obstetricians, pediatricians, and other specialists as the need arises. 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.
Doulas do not provide medical care and do not deliver babies. Midwives are trained to provide all the necessary medical care and to monitor the health and well-being of you and your baby. Doulas work as a part of the team, with a midwife or doctor and nurse. Doulas provide continuous emotional and physical support to the laboring woman and her partner, and are a positive addition to the birth team for couples who want extra support. For more information about doulas, please see the Doulas of North America Website or the BC Doula Services Association.