Midwives: Care during pregnancy and delivery

Ever since midwifery was legalized in Quebec in 1999, women have been able to choose a midwife to provide prenatal and postpartum care as well as support during labour and delivery. A midwife offers personalized care, establishing a relationship with the mother-to-be that is based on equality and collaboration.

The practice of midwifery

A midwife is a health care professional who provides care and services during pregnancy, delivery, and the first 6 weeks after birth. To be cared for by a midwife, a woman must be healthy, and her pregnancy must be progressing normally. This is usually the case for 80% of expectant mothers.

A midwife is a member of a professional order that ensures the protection of the public. Entering the profession requires completing a four-and-a-half-year university program. Midwives therefore have the necessary knowledge to provide women with safe care, quickly detect potential complications, and respond appropriately to emergency situations. They can also prescribe any medications or tests that mom or baby may require while under their care. If complications arise, the midwife will consult a physician or transfer the mother’s care to a physician.

Midwifery is based on respect for pregnancy and childbirth as normal physiological processes. Midwives therefore favour a holistic approach and respect parents’ choices.

They work in teams of two or three to ensure there is always a midwife available to look after the mother’s needs (24 hours a day, 7 days a week). One member of the team will be specifically assigned to the client and provide most of her care. However, she will meet the other midwives during her third trimester so that she feels at ease should one of them be on call when she goes into labour.

A midwife can provide support during labour and birth in a birthing centre, at the hospital, or at home. Their approach will be the same regardless of the birth location. In all cases, midwifery services are covered by the Régie de l’assurance maladie du Québec.

Finding and being cared for by a midwife

A woman who is interested in midwifery care must first apply at her local birthing centre. She will then be invited to an information meeting with a midwife, which will be held at the birthing centre prior to the start of care. At the first appointment, the midwife will assess the woman’s eligibility for midwifery care.

In general, moms-to-be have 10–12 prenatal visits with a midwife. Appointments occur once a month for the first few months, becoming more frequent as the pregnancy advances. Each one lasts approximately 50 minutes.

The expectant mom may bring her partner or anyone else she’d like, including kids. Most consultations take the form of a dialogue, where the woman can discuss any concerns with her midwife. Potential topics include nutrition, common ailments during pregnancy, and available tests. The midwife will also help her client prepare for childbirth by discussing the options at her disposal, among other things. In addition, the midwifery team will offer prenatal classes.

During prenatal visits, the midwife checks that the pregnancy is going well. They perform clinical examinations and can order tests and analyses, as well as ultrasounds. They can also take samples to have them analyzed at a hospital centre, which will send back the results.

Pregnancy monitoring takes place at the birthing centre. However, the midwife will help the expectant mom choose a birth location during pregnancy. About 75% of births overseen by a midwife take place at birthing centres, 20% occur at home, and 5% occur in hospitals.

Childbirth with a midwife

At the first signs of labour, the pregnant woman will contact her primary midwife or a team member, depending on the on-call schedule provided in advance. The midwife will then head to the chosen birth location to meet her. Midwives are alone with their client during the first stage of labour.

While the midwife is responsible for ensuring that labour goes smoothly and that the baby is okay, the mother-to-be chooses the positions she finds most comfortable. She’s also free to choose whether she wants to eat, listen to music, or relax in a bath.

Another midwife will arrive just before delivery, when it’s time to push. This may be their first time meeting the client. The second midwife’s role is to assist the primary midwife during the second stage of labour. A birth attendant may also be present to provide additional assistance.

In the event of complications during labour, the midwife will consult a physician and transfer care to a medical team if necessary. About 16%–18% of births that begin with a midwife are ultimately transferred to a hospital. These are rarely urgent cases; most are done on a preventive basis. The two main reasons for transferring care are prolonged labour and a request for an epidural.

Birthing centres

Birthing centres are small, welcoming spaces that operate within the health care system and provide an alternative to hospitals. The number of women being cared for at a particular birthing centre is limited to maintain a sense of intimacy.

Birthing centres are also designed to provide a family setting for the women they serve. Family and children are welcome. Many birthing centres have a playroom for kids, as well as a kitchen and living room for parents.

Birthing centres offer all the necessary conditions for a safe delivery. They have all the equipment and medications required to respond to emergencies. In addition, they are fully prepared to transfer clients by ambulance to a hospital if necessary. If transfer of care to a physician is necessary, the midwife will accompany mother and baby and remain in charge of their care until the team at the hospital takes over.

Home delivery

If a woman chooses to give birth at home, her midwife will provide her with a form to sign with the information she needs to make an informed choice. This document will cover the details, advantages, and risks of each birth location. It will also describe situations requiring transfer to a hospital, emergency measures in the event of complications, and the criteria for transportation from the client’s home to the hospital.

Prior to the 36th week of pregnancy, the midwife conducts a home visit. This allows them to determine whether the residence is accessible to paramedics and within reasonable distance of a hospital.

When attending to a home birth, midwives have all the necessary equipment and medications to respond in an emergency. An agreement with the nearest hospital also ensures that the client or her baby can be transferred quickly if necessary.

A 2015 Ontario study concluded that planned, midwife-assisted home births are safe and may even result in fewer interventions for healthy women.

Things to keep in mind

• A midwife is a health care professional who provides care and services during pregnancy, delivery, and the postpartum period.
• A midwife can attend a birth in a birthing centre, at home, or in a hospital.
• To be followed by a midwife, the mother-to-be must be healthy, and her pregnancy must be progressing normally, which is the case in about 80% of pregnancies.

Scientific review: Claudia Faille, midwife Research and copywriting: The Naître et grandir team Updated: September 2020

Photo: iStock.com/kzenon