The importance of maintaining primary care
One of the main reasons clients choose midwifery care is that they will know the midwife who will attend their birth. That continuity of care is important in many ways – it builds trust between client and provider, ensures the midwife is familiar with her client’s health and relevant personal information, and helps to keep birth normal.
Because research shows strong benefits, the Association of Ontario Midwives (AOM) supports midwives in maintaining primary care for clients who access induction,
augmentation or epidural. As primary care providers who are key to the provision of maternity care in this province, midwives should be enabled to work to the scope of practice outlined in The Midwifery Act and by the College of Midwives of Ontario.
Unfortunately, that’s not always the case.
In 2011, the government surveyed midwives and found that about half of Ontario’s maternity care hospitals have policies that restrict midwives’ scope of practice resulting in nonmedical, unnecessary transfers of care from midwives to physicians. This leads to additional costs to the health-care system and, as a recent international study also points out, clients experience poorer outcomes when midwives don’t maintain continuity of care.
On the bright side, many hospitals and midwives are working together to ensure midwives maintain primary care for their clients within their scope of practice.
In Kingston, an innovative interprofessional collaborative practice model has ensured that midwives now manage epidural care for their clients.
In Ottawa, midwives who have experience with breech deliveries maintain primary care for their clients.
And a team approach presides in Fergus as well, where excellent interprofessional relationships ensure midwives work with other providers to establish hospital policies and protocols.
Aboriginal midwives at Six Nations offer comprehensive care to their clients and broadly to members of their community. In addition to caring for women from conception to birth, they offer health education, disease screening, well-woman care and cultural teachings for women of all ages.
Midwives are primary care providers. As such, the AOM does not see it as appropriate to shift primary care to another caregiver when the ability to provide that care lies wholly within the scope of midwifery. Enabling midwives to maintain primary care in instances that are clinically indicated provides the following benefits:
• Enhances client safety
• Keeps birth normal
• Enhances continuity of care
• Maximizes efficient use of health-care resources*
Improving the integration of midwives does not solely reside with midwives. In some hospitals and communities, despite the best efforts of midwives, integration is still stalled. Hospital and
government leadership are needed to ensure the scope of practice of midwives is optimized and that midwives are leveraged to support Ontario’s health care transformation agenda.
I am inspired by the stories of successful integration and interprofessional collaboration that follow, and I hope you are too. Ending unnecessary transfers of care from midwives to physicians would benefit clients, care providers and the health-care system. It’s time for all hospitals to align with the province’s health care transformation agenda, follow the examples of those featured in this issue of Ontario Midwife and ensure midwives maintain primary care for their clients.
by Lisa M. Weston, President