Part 1 - Overview of the Canadian Model of Midwifery Practice

While midwifery laws, regulations and policies are somewhat different in each Canadian province or territory, the model of midwifery practice is similar across the country.

The basic characteristics of this model may give you a sense of the responsibilities and realities of working as a midwife in Canada. These include:

Primary Care

Canadian midwives provide the full continuum of primary (low risk) maternity and newborn care, from early pregnancy through labour and birth and up to at least six weeks postpartum (rather than working in a single area such as a Labour and Delivery Unit). Women can access a midwife directly without being referred by a doctor. Midwives are fully responsible for making clinical decisions and managing care within their scope of practice. This includes identifying abnormalities and conditions that require consultation or referral to specialists or other health professionals.

Community-based Practice

Canadian midwives usually work in small group practices in community settings, such as health clinics or private offices, and have admitting and discharge privileges in hospitals. Midwives provide prenatal care in their offices, make home visits as needed, and attend births in hospitals, birthing centres or at home. Home visits are a regular part of midwifery care in the first weeks postpartum.

Continuity of Care

Canadian midwives provide individualised care with continuity through pregnancy, childbirth and the postpartum period. Practices are organized so that clients and midwives can get to know each other and develop a relationship. A fulltime midwife carries a caseload of about 40 clients per year. On-call coverage is shared among a small number of practice partners to ensure that a midwife familiar to the woman is available and present for the birth.

Informed Choice

Canadian midwives support the woman’s right to make informed choices about her care. Midwives regard the woman as the primary decision-maker and contribute their professional knowledge and recommendations in a manner that is non-authoritarian and empowering. Midwifery visits allow adequate time (30-60 minutes) for education and discussion.

Choice of Birth Setting

Canadian midwives support the woman’s right to choose where she would like to give birth. Midwives make appropriate recommendations regarding safety and are prepared to provide intrapartum care in both hospital and out-of-hospital settings, in accordance with professional standards.

As you proceed through this self assessment tool, it is important to reflect on the Canadian midwifery model and your professional and personal ability to:

Work in partnership with the woman
 
Honour the individual needs and wishes of the woman and her family
 
Promote and facilitate the normal process of childbirth
 
Respect diversity and provide culturally sensitive care
 
Apply the principles of therapeutic counseling and adult education
 
Review current research findings and apply the best evidence to midwifery practice
 
Share evidence-based information about tests, treatments and interventions with the woman and her family
 
Support the woman’s own decision-making process
 
Discuss potential complications and risks in a balanced, non-alarmist manner
 
Provide continuous support and comfort measures during labour
 
Use medical/obstetrical technologies as needed (not as a routine)
 
Use alternative or complementary therapies appropriately
 
Document relevant assessments, recommendations and treatments in clear professional language
 
Apply critical thinking and effective communication skills
 
Understand the legal aspects of midwifery practice, e.g. confidentiality, freedom of information, informed choice and consent
 
Understand the regulations, standards, policies and ethical frameworks governing midwifery
 
Understand the structures and processes of the Canadian health care system.

Midwifery Work and Lifestyle

Working in the Canadian midwifery model is very rewarding and enjoyable, but it also has its challenges and demands. It is very important to consider the following questions:

Note: Midwifery bridging programs are designed to orient internationally-educated midwives to Canadian midwifery practice. A bridging program will help you to adjust to the way midwives work in Canada and the professional and lifestyle realities involved. For example, if you have not attended home births or are not familiar with certain hospital procedures and technologies, you can gain this experience within a bridging program.

Are you confident working autonomously as a primary care provider?
You and your practice partners will be managing primary (low risk) maternity care and making clinical decisions on your own responsibility through the complete course of pregnancy, labour, birth and the postpartum, including examination and care of the newborn. This means working independently without being supervised or directed by other health care professionals. Physicians are not involved in the care of midwifery clients or present at deliveries unless a consultation or transfer of care is needed.
Are you comfortable working in a hospital setting?
As part of your practice you will be attending births in hospitals. You will need to be familiar with hospital systems: procedures for admitting and discharging patients, policies for labour and delivery, postpartum and newborn care, and the various departments and services involved (ultrasound, laboratory, blood bank, high risk clinics, neonatal intensive care, social work etc). You will also need to be comfortable using hospital equipment and technologies (IV pumps, electronic fetal monitoring, infant warmers, electronic charting etc). Your work in some hospitals may include managing continuous epidural infusions, induction or augmentation of labour, and other medical/technical procedures.
Are you comfortable working outside a hospital and attending home births?
Your midwifery practice will include home birth, which involves working competently in a variety of private home settings without immediately available hospital technology. Some midwives also work in rural or remote communities where there is no rapid access to a hospital. These situations require particular skills in preventative care, risk screening and emergency measures.
Are you familiar and at ease with informed choice and woman-centred practice?
Woman-centred midwifery practice involves getting to know the woman, who she is and what she needs in the process of pregnancy and birth, and supporting her confidence in her own abilities. It also involves sharing information and offering choices about tests and procedures, enabling the woman to make decisions for herself. This requires a style of conversation and education that is interactive and empowering rather than "didactic" or directive.
Can you manage an unpredictable work schedule?
You and your practice partners will be sharing a call system to ensure that your clients can access a midwife 24 hours a day, 7 days a week, including weekends and holidays. You may be "on call" for periods of time instead of working regular hours; midwives in Canada do not work shifts the way nurses do for example. Because midwifery caseloads are limited in volume, your actual work hours will balance out overall. Some days will be long and very busy with births, phone calls and visits: other days may be relatively quiet with no one in labour – depending on how on-call coverage and tasks are organized within your midwifery team.
How do you cope with lack of sleep?
When you attend a birth you will be staying with the woman and providing care and support throughout active labour, the delivery and the first few hours after the baby is born - day or night. Your practice partners will assist you or cover for you when you are overtired and in need of a rest: nevertheless, your work as a midwife will inevitably involve some nights with interrupted sleep or lack of sleep.
If you have young children, will you have the necessary childcare?
When you are on call, you must be available to go to a birth or respond to urgent matters at any hour of the day or night. If your children are too young to be on their own, you will need around-the-clock childcare or another adult in the house, to enable you to leave immediately after receiving a call.
Is your spouse/partner and family supportive of the midwifery work you would be expected to do?
Working as a midwife in Canada, providing continuity of care and being on call involves unpredictable hours and some absences from home that can be hard for midwives’ partners and families to cope with. You may at certain times have to miss family events like birthdays or social occasions with friends. It is much easier to balance your work and family responsibilities if you have the support and understanding of your partner and family members.
Do you have a car and a valid Canadian driver’s license?
Traveling to clients’ homes and hospitals (and getting there quickly if a birth is in progress) requires a reliable car that is available to you at all times. You will also need to be able to drive alone (i.e. without an escort) at any hour, in rural, remote and city locations and under variable weather conditions.
Are you able to develop good working relationships with medical and nursing colleagues?
Midwifery in Canada is still a "new" profession that other health care providers do not always fully understand or recognize. You may sometimes find yourself working in an environment where midwives are not well regarded and professional interactions are complex. Diplomacy and respectful communication skills are important in developing collaborative team relationships.
Are you able to contribute to the development of the midwifery profession?
Most midwives in Canada are involved in some aspect of building their profession in addition to clinical practice: teaching or mentoring students, developing policy, doing research, participating on hospital and community committees, and speaking to the public. You will be expected to take part in some of these tasks.
 
If/when you apply for midwifery registration in Canada, you will be required to take part in a formal assessment and bridging program to ensure that your knowledge and skills meet Canadian standards. This process includes interviews, language fluency tests, written and oral/clinical examinations, orientation sessions, and courses to remedy competency gaps.


 

More Information

Visit the Canadian Midwifery Regulators Council website for:

  • Information on midwifery assessment and bridging programs
  • Descriptive examples of "a day in the life" of Canadian midwives
  • Information on midwifery working conditions in different provinces/territories