What is a midwife?

If you are a midwife, want to be a midwife or want to be in midwifery care, you will encounter at least once, if not a thousand times, when people ask you what a midwife is and what kinds of work they do.

My response?

a) The One Liner:
Me: I assist women through their journey in pregnancy to approximately six weeks after their baby is born.
Them: Huh?
Me: I deliver babies.

b) The Story:
Me: I assist women through their journey in pregnancy to approximately six weeks after their baby is born.
Them: How so? or What do you mean?
Me: Well,

What a midwife in one location does (scope of practice) is really different than what another midwife does in another location. I say location because there are differences between countries, between provinces/states and between cities. What a month in the life of a midwife in an urban setting looks like is rather different than what a month in the life of a midwife looks like in a rural setting. Midwifery is one of the oldest professions that has ever existed, but since the drastic growth in Western medicine and the hospital model came to be, midwifery was slowly lost. After the profession of midwifery declined, there were many problems that occurred. Indigenous people in rural parts of Canada were required to fly into larger cities away from their families for weeks and sometimes months to deliver their babies. People who had religious or cultural practices were restricted from the hospital rules. It wasn’t until 1994 when Ontario has decided to regulate the practice of midwifery again.

What do midwives do? (Scope of practice)

  • Midwives have scheduled prenatal appointments with their clients — usually 45 minutes to an hour long to hopefully answer all the questions you have and take the time to properly apply informed choice (I will explain this more in depth later).
  • Midwives are on call 24/7, yes, we carry pagers everywhere because you can’t control when a baby will be born and we value continuity of care. Of course, we have breaks as well — this is different per clinic and how the clinic works in terms of who is on call and how long that person is on call for.
  • Midwives are primary healthcare providers who are able to write healthcare requisition forms for ultrasounds, blood tests, etc. Midwives are able to prescribe certain medications related to pregnancy. However, midwives cannot perform Caesarean sections. Midwives are trained to perform epidurals, but there may be hospital rules which prohibit midwives from doing the actual epidural. In the case that complications arise with your pregnancy, midwives will refer you to an obstetrician to decide what is best for your care (transfer of care).
  • Midwives are different from labour delivery nurses who work mainly at the hospital and are on shifts. These awesome nurses assist during the delivering portion of your pregnancy and also provide assistance after your baby is born.
  • Midwives are different from doulas who work as a support person for you before, during and after your pregnancy if that’s what you request. Unfortunately doulas are not covered by OHIP at the moment, but are spectacular people that have a superb amount of experience with labour support. If you want a Caesarean Section, labour support and continuity of care, you may want to look into hiring a doula!
  • When a person realizes they are pregnant, they have the option to decide if they want a midwife or an obstetrician in Ontario Canada. Both of these professions are covered by OHIP. Some family doctors work as midwives — so if that’s what you are looking for, that is an option too depending on your healthcare provider!

The midwifery model focuses three main things:

  1. Informed Choice 
    Our job is to allow you to make the best choice based on what it is you feel like you want or what works best for you. We will list out all the possible outcomes in your care, the benefits and risks and ultimately letting YOU decide if that’s what you want in your care — for example, something like: Would you want an ultrasound?
  2. Continuity of Care 
    You will get to see the same person or group of people at every prenatal visit (prenatal meaning before your birth), till the point of your delivery to six weeks after your baby is born.
  3. Choice of Birthplace
    You will be able to decide where it is you want to deliver a baby. Not everyone likes delivering at hospitals, not everyone likes delivering at home. Some people want to deliver at a birth centre. Some people might feel like they don’t have the space in their homes, feel a greater trusting relationship with doctors, want to be present at a site in case of emergencies, or simply prefer the hospital more. Other people may feel that the hospital has too many restrictions such as the number of people that can be present at birth, cultural ceremonies involving incense and candles, and many more individual reasons.

Of course, this isn’t to say that I have encompassed every aspect of what a midwife does, nor have I possible encompassed all the aspects to why people select hospital care or midwifery care. This post is not to say that midwives are better than doctors, or that doctors are better than midwives. It is simply a post that I wrote to explain what a midwife does in Toronto to allow people to decide the type of care they want!

I hope it answers some of your questions!