With midwifery, the focus is on continuity of care

When Amber McLachlin became pregnant, her previous frustrations with the healthcare system led her to seek alternative forms of care for the pregnancy and delivery.  “I’ve never liked hospitals. So at the time, when I found out that I was pregnant, I started listening to a lot of podcasts about preg

Last updated on May 03, 23

Posted on Mar 03, 23

4 min read

When Amber McLachlin became pregnant, her previous frustrations with the healthcare system led her to seek alternative forms of care for the pregnancy and delivery.

“I’ve never liked hospitals. So at the time, when I found out that I was pregnant, I started listening to a lot of podcasts about pregnancy, and a couple of the podcast producers had had experiences with midwives,” McLachlin said.

This led her to the St. Jacobs Midwives clinic, where she was cared for by a three-person team for the pregnancy and birth. This was followed by weekly appointments for six weeks postpartum.

“From day one, the care was so much better than what my regular doctor did, it was much more personalized. There’s no rushing in the appointments. There’s time to answer questions,” McLachlin explained.

“I just find our healthcare is mostly like, ‘Oh, you’re in pain, here’s some pills’ and obviously, with pregnancy it’s a whole other thing. But there’s just more care and listening to the patients and not just a giving-out-prescriptions kind of thing. It’s just more tailored to the person and more caring,” she added.

That personal care makes midwifery care a good alternative, said Andrea Horst, office manager at the St. Jacobs clinic.

“You get to know a very small group of providers. And they see those midwives from the very beginning all the way through … whereas if you’re going the obstetrician route, you would see your family doctor or nurse practitioner for the first six months, then you’d be referred to an OB and you’d see them for the last three months of your pregnancy. Then when you go to the hospital, nurses care for you and whichever OB happens to be on call, which may or may not be the one that you’ve been seeing for the last three months. And then after your delivery, you go back to the family doctor,” Horst said.

“And so it’s very chopped up and convoluted and various people sort of not quite knowing what’s going on in your care.”

Horst said that care from the same midwifery team might continue for several years and multiple pregnancies.

“And so they know her, she knows them, they have a trusting relationship. They know what’s normal for her. They know that ‘oh,  she always goes a week late,’ or she always measures on the small-size side, but she ends up having normal-size babies.’ “

Around 18 per cent of births in Ontario happened under midwifery care in 2022, according to the Association of Ontario Midwives.

The midwives in St. Jacobs traces its roots to the 1980s before midwifery became a regulated health profession in Ontario in 1994. The suite at the clinic opened in April of last year. Around 25 per cent of its clients, including McLachlin, chose to give birth in that suite. Each midwifery team at the clinic always has one person on call.

According to Horst, midwives deal with low-risk pregnancies, while higher-risk pregnancies will be seen by an obstetrician.

“So maybe somebody with a pre-existing heart condition, someone with multiples, like having triplets, or you know, something that puts them at higher risk, they would all be cared for by the OBGYN.”

However, midwives can do many things OBGYNs do, including ordering diagnostic tests, managing labour and delivery, hospital admittance and providing epidurals. They can also provide home births if the patient chooses that route.

For midwife Jenessa Otto, having that choice is a key part of what sets the profession apart.

“To my knowledge we’re the only medical professionals in Ontario that offer out of hospital birth as part of our scope. I don’t think that there are many doctors that are offering that in Ontario. They do in some parts of BC, there’s a few so if someone wants an out of hospital birth, that might be a reason they come to a midwife,” Otto said.

However, there are certain requirements to having an at-home birth, including being at least 37 weeks pregnant, as anything before that is considered preterm. Epidurals must also be administered in a hospital, Horst explained.

“If somebody requires a caesarean delivery or an assisted delivery of some sort, it has to be in the hospital, and there are people that an out-of-hospital birth would never be recommended. If we’re unsure of a baby’s position for example, they would be recommended a hospital birth,” she said.

Horst added that the aim is not to replace care from obstetricians but to provide a choice.

“Normal, low-risk, healthy people should have the choice of care providers, and choice of where they want to deliver. Ultimately it’s the parents’ choice what they want to do or where they want to deliver. It doesn’t make any difference, the midwives are happy to deliver them at home, clinic, or hospital.”

While McLachlin wanted to have an at-home birth, her husband had some reservations, making the St. Jacobs clinic a good middle-ground. However, her family and friends were still not on board.

“They were not for it…because it’s going against the norm. So they were…questioning everything. I just wanted to try it. When I met the midwives, I was like, ‘I have a good feeling about this.’”

With plans to have another child, McLachlin hopes to have a home birth. She encourages anyone hesitant to use midwifery care to speak to those who have used it.

“Definitely have conversations with people that have had experience with [midwifery]. And if there’s still hesitation, go and speak to a midwife, specifically, and ask questions, and maybe go to the facility. I feel like that would ease people’s nerves if they were on the fence about it.”

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