More and more Ottawa parents are choosing midwives to attend the births of their babies, and for excellent reason, Tracey Tong writes
When Meghan Good found out she was expecting her first child, she immediately knew she wanted a midwife.
“I filled out the intake form the day I found out I was pregnant,” says the Ottawa resident, who had heard positive experiences from other families. “I love the midwifery approach to pregnancy and births – it’s one of the most natural, primal experiences I would ever have.”
She and her husband, Andrew, welcomed their first child in 2013 at a hospital, with only midwives present. Good wasn’t disappointed with the experience. “I found the gentle, compassionate, informed choice approach empowering,” she says.
They used a midwife again for their second child, born in 2015 at the Ottawa Birth and Wellness Centre, and for their third child, born at home in 2017.
“The postnatal care is wonderful as well,” Good adds. “Having the midwives visit us at home every couple of days after the birth, rather than having to take a newborn to a clinic or hospital for check ups, is another great aspect of midwifery care. While the births have been very physically and mentally challenging, I feel very positive about the beautiful ways I was able to being my children into the world, and I owe a lot of that to the support I received (from) my midwives. Being able to labour and birth surrounded by people I love and am comfortable with, my partner and midwives, really helps put me in the necessary, focused state of mind.”
The family is now expecting a fourth child, with a planned home birth under midwifery care. “I can’t recommend midwife care enough,” says Good. “I would love to see more support given to the practices to be able to expand since there is such a high demand in Ottawa for their care.”
Ottawa resident Crystal Pruys also recommends midwife care after having three “amazing” birth experiences, both before and after giving birth.
When her daughter, now 13, was born, Pruys was home from the hospital less than four hours later. She had the same midwife attend her son’s home birth 10 years ago. She also used a midwife with the birth of the baby she carried as a surrogate.
More and more women and their partners are seeking out the services of midwives – which means “with woman” – in Ottawa. In response, midwifery continues to grow as a profession – there are 1,000 midwives in Ontario, where women have the option of choosing a midwife, a family doctor, or an obstetrician as their primary care provider for their pregnancy and birth – and the care is covered by the Ontario Ministry of Health and Long-Term Care, and is available free to anyone with a home address in Ontario.
Healthcare professionals specializing in low-risk birth, midwives are university-educated and provide primary care to pregnant people and their newborns through pregnancy, labour, birth, and for the first six weeks after birth.
Midwifery philosophy and approach to care is based on three main pillars, says Geneviève Gagnon, a registered midwife and practice partner at East Ottawa Midwives who has privileges at the Montfort Hospital and The Ottawa Birth and Wellness Centre, where she is the clinical lead midwife. These include informed choice, choice of birthplace (hospital, birth centre or home) and continuity of care. The care that midwives provide is built on respect for pregnancy as a normal rite of passage that builds on trust between the midwife and the birthing person/family’s wishes.
As autonomous healthcare providers, midwives provide front-line health care by seeing patients directly (like a nurse or a physician), order their own laboratory tests and ultrasounds, write their own prescriptions, and provide care on their own authority, not under the direction of a physician, says Nicole Pichette, a registered midwife with Ottawa South Midwives.
“As midwives are experts in low-risk pregnancy and birth, midwifery clients will not see a physician unless there are concerns or complications,” says Gagnon. “If complications arise, midwives can consult with physicians or, if necessary, transfer a client’s care to a physician.”
Even if a complication arises, a patient can keep their midwife involved or as a main care provider, says Pichette. “For example, if a person begins to have issues with their thyroid during pregnancy, they will be referred to an endocrinologist for medication. Their midwife continues to manage their pregnancy as normal, as long as this is well controlled.”
People who are not eligible for midwifery care include those with pre-existing conditions, such as renal disease, cardiac disease, or pre-existing hypertension, that make them high risk, says Pichette.
A person can start looking for a midwife as soon as she finds out she is pregnant.
In Ottawa, there are several options for midwifery clinics, but they still go quickly, says Pichette. Gagnon adds: “It is beneficial to access prenatal care at the beginning of your pregnancy. You don’t need a referral from a doctor to have a midwife, just contact your local clinic directly.” Those who are late to the game shouldn’t worry too much. “Some midwives end up with open spots unexpectedly,” says Pichette.
Midwives are reachable for any emergencies/assessments that need to be done while pregnant, says Pichette. “When a client goes into labour, their midwife is available 24/7 to attend them in labour and deliver their baby,” she says.
According to both women, this is the toughest aspect of their profession. “Being on-call for this moment means we live a different lifestyle; one where the call comes and where you have to stop everything you are doing and change your plans – like leaving the groceries in the cart in the middle of the aisle, or making your way out of a crowd when you decided to go watch a show at Bluesfest,” says Gagnon.
Pichette says she never know when she will be called by someone needing care. “It often occurs in the middle of the night, during a storm, or on a weekend,” she says. “We sometimes are awake through the night with our clients. We sometimes have to say goodbye to our families to attend a birth for an undetermined amount of time, and that can be difficult for us and our loved ones. In addition, midwives routinely handle and manage high intensity situations and emergencies, and this is not always understood well by those who do not understand the scope of midwifery care.”
By and large, the role of midwives is still poorly understood, Pichette continues.
“If you ask a group of people about midwives, you usually get a few whose faces light up and who have wonderful things to say about midwifery care, and a few whose faces go blank and say, ‘what’s a midwife?’” Pichette says.
Gagnon believes people hear about midwives in the news or on television, or learn about what they do from family or friends who have received care from midwives. “I do believe shows like Call the Midwife or SOS Sage-femme, have helped the public, and even my own family, understand what we do as part of the labor and birth process,” she says.
Even with a growing pool of information out there, misconceptions still exist – and the biggest one, Pichette says, is that midwives are hippies who only want to support out-of-hospital, unmedicated deliveries.
This is not true at all, Pichette says. Approximately 75 percent of births involving midwives take place in hospital, where the labouring woman is choosing epidural pain relief, but ultimately, it is the woman’s choice. “We want our pregnant clients to feel empowered to make the right healthcare decisions for themselves and their families with the best evidence available,” Pichette says. “Whether this means a home birth, a hospital birth or a birth centre birth is up to the birthing family.”
Another misconception is that midwives can’t deal with obstetric emergencies when they come up, and that they wouldn’t have the knowledge or skills to involve other care providers if needed. “We are skilled to be able to recognize when something might be starting to go awry, and act immediately, which is why our outcomes are so excellent,” she says.
For both women, this job rewards again and again.
Pichette’s favourite memories include involving partners in catching the baby, having older children to watch a sibling’s birth, and helping to provide a healing experience for the birth of a second baby, when the first birth was not an empowering or positive experience.
“I have also felt a great deal of joy in passing a baby to a birthing person who I know has been trying to conceive for several years and has waited so long for that moment. I feel most satisfied in seeing the look on a parent’s face as they receive their baby for the first time,” Pichette says.
The most rewarding thing about this midwifery work are the interesting people and families we meet, our incredible colleagues and healthcare providers we work with, and the babies we hold,” says Gagnon. “It is a privilege to attend anyone’s birth, and I have been blessed with incredible privilege to do this work.”
“It is incredibly rewarding to watch babies grow from the kicking in-utero baby to a growing, thriving baby on the outside! And wonderful to watch people become parents.”
– Nicole Pichette, registered midwife
How to find a midwife
- Look for a care provider that works for you and will make you the most comfortable, Gagnon says. Pregnant people can go to any of the midwifery clinic websites in the city and fill in an intake form through a self-referral process.
- At the initial appointment, the midwife will go through many details including how they work, where they have privileges, the length of their appointments (typically 30- to 45 minutes long) as well as the basics about midwifery care, says Gagnon. “The client will get a feel for how the midwife communicates and can make a choice after that appointment whether or not they will continue care with that midwife. Ideally, if a client is undecided between a midwife or physician, they should meet both and then decide. Again, it’s whatever makes them most comfortable and will give them the optimal birth experience,” Gagnon concludes.
- Although they are usually assigned a “primary” midwife, women will get to know a small team of midwives, Pichette says. “This is done so that a pregnant person can meet some “backup” midwives who will care for them if they go into labour or need an assessment when their primary midwife is off for a vacation or a scheduled weekend off.”
- Keep in mind that in the end, a midwife is a trained health professional, and a client is not necessarily going to “click” with them in the same way they would a new friend, says Gagnon. “However, they should feel comfortable communicating openly with their midwife and many clients go on to have very meaningful, close relationships with their midwives.”
What to expect (from a midwife) when you’re expecting
– Amazing level of quality maternity care from their midwives;
– Family-centred care;
– Availability by pager 24 hours a day, seven days a week;
– Informed choice discussions throughout care about procedures, testing, birthing options, postpartum care, etc.;
– The opportunity to ask questions and find out about options;
– A holistic approach to care that encompasses not only medical care but mental and emotional health and well being;
– Regularly scheduled visits to the midwifery clinic;
– Six weeks of postpartum care for mom and baby, usually at home. After six weeks, clients are discharged from midwifery care and will see their family doctor for care.