Hospital Integration

Physician looks on as midwife holds baby

The Issues

Although 75% of midwifery clients choose to give birth in hospital, hospitals sometimes present barriers that prevent midwives from attending births. Hospital integration challenges for midwives typically fall under one of these categories:

  • Applying for and securing hospital privileges
  • Caps on the number of midwives with privileges
  • Caps on the number of midwifery-attended births
  • Scope of practice restrictions

However, sometimes there is an underlying conflict within the hospital that is the real issue, and manifests itself in the guise of these restrictions. Untangling the heart of the conflict and exploring paths to mutually beneficial solutions is something staff at the AOM can help midwives with.

Support from the AOM

The reasons for these integration challenges are most often rooted in some kind of interprofessional conflict, either at a systems level or on a personal level, generated by a scarcity of resources/money or a lack of trust. Midwives facing these challenges are encouraged to contact the AOM to discuss how midwives may develop an advocacy strategy. Midwives often seek support such as:

  • Looking for position statements that support strong interprofessional care/collaboration
  • Data relating to what other hospitals of certain sizes (Level 1, 2, 3) or similar demographics (rural, small rural, urban) do under particular circumstances
  • Provincial-level BORN data
  • Finding protocols or guidelines in relation to clinical care that can be replicated
  • Reviewing hospital by-laws or other documents
  • Discussing funding mechanisms

When you contact us, staff may want to know:

  • Is the head midwife supportive?
  • What are the circumstances that have led up to the situation you’re facing?
  • What advocacy efforts have you tried up to this point?
  • Who are your allies and opponents within the unit and at administrative levels?
  • Is there a midwife sitting on the Medical Advisory Committee?
  • What proportion is the midwifery birth volume of the total hospital birth volume?

In most instances, the AOM will advise an advocacy strategy that identifies how to influence the primary barriers. The strategy most often begins by working with the head midwife, moves up to the chief of the department, and escalates further up to hospital administration officials who may be able to help (e.g. Ethics Officer, Patient Advocate, VP Patient Affairs, etc.). Engaging local supporters and calling the media are most often the final steps in any advocacy strategy.

Ways We Can Help

Other strategies midwives also sometimes consider include:

  • establishing a department of midwifery
  • getting a midwife sitting on the Medical Advisory Committee
  • working with the AOM to have HIROC and/or CMPA make a presentation
  • working with the hospital to conduct an impact analysis to determine the financial costs of optimizing midwives
  • doing rounds (the AOM has slide decks and other resources you can customize for your community--contact us for more info)
  • drawing on experience from head midwives across the province

Additional Resources:


The following slide decks written by the AOM are available by emailing Vincia Herbert:

  • Midwifery and Epidural: Working Towards Epidural Certification at Your Hospital
  • Induction/Augmentation: Working Towards Certification at Your Hospital
  • Opening Doors: Midwifery in Ontario




HIROC Risk Reference Sheets on Interprofessional Hospital Conflicts and Failure/Delay in Consulting or Transferring Care

HIROC Risk Notes: Medical Directives



    Sample Hospital Policies are available at the bottom of the members-only protocols page.