Dear Dr. Mark Walker, Dr. Virginia Roth and Mr. Cameron Love,

In April of 2018, I had a baby who was delivered by my phenomenal midwifes at the Community Midwives of Ottawa. The tremendously positive care experience I enjoyed during and after my child’s birth has made me a strong advocate and supporter of midwifery services here in Ottawa and beyond.

As a midwifery client, I would like to advocate for the expansion of midwifery services in Ottawa’s hospitals and other needed expansions for accessing midwifery care in our community. I am troubled to know that there are people currently on waitlists for midwifery care who will not be able to have a midwife due to restrictions on midwifery hospital privileges. These restrictions obviously impact choice of birthplace, as well as choice of care provider, for countless women and families, needlessly limiting the range of quality birth experiences to which they should rightfully have access.

CMNRP recently released a Capacity Plan outlining the needs of our community and identified that “given women in the region requested increased access to midwifery services, midwifery privileging processes at each hospital should be reviewed and opportunities to increase the number of midwifery supported births at OBWC should be explored.” You can consult the report here: http://www.cmnrp.ca/en/cmnrp/Capacity_Plan_Final_Report_2019_p4924.html

I am glad to join my voice with a chorus of others to draw your attention to this important concern. We need a reassessment of midwifery privileges at Ottawa hospitals and beyond so that more midwives can be hired, and more clients can access midwifery care.

I look forward to hearing from you on this important issue.

Sincerely,
Karen Hébert
Assistant Professor
Department of Geography and Environmental Studies
Carleton University
Loeb Building A325
1125 Colonel By Drive
Ottawa, ON K1S 5B6
karen.hebert@carleton.ca

Hello Dr. Walker, Dr. Roth, and Mr. Cove,

As a midwifery client who gave birth to my first little one in May, I’m writing to add my voice to those who have already spoken out requesting the expansion of practicing privileges for midwives, especially in the Ottawa area.

There are tremendous benefits associated with providing childbearing people with assured continuity of care throughout pregnancy, labour, and delivery. I know for me, having access to midwifery care was an exceedingly positive and ultimately life-changing experience.

Due to a rare chromosomal translocation, choosing a care provider when I found out I was pregnant was an anxiety-ridden experience for me. I was overjoyed, but had also been through extensive genetic counseling prior to becoming pregnant and understood that depending on the way the translocation presented, there was a 50% chance that the child would have severe developmental problems and a 25% chance that those problems would be so severe that the child could not survive.

Because my pregnancy was classified as high risk until the worst genetic outcomes were ruled out, I initially had a difficult time finding a care provider. I was very lucky to connect with Ola at Community Midwives of Ottawa, who not only provided top-notch medical care, but also extensive emotional support as I went through the genetic screening process, awaited the results, and mentally/emotionally prepared myself to make some very difficult decisions about the future of my family. Although it was an extremely tumultuous time in my life, I can honestly say that I have never felt as supported and empowered as I did working through it with my midwives. Luckily, the our daughter did not inherit the translocation, and I’m grateful that the people who were there throughout the uncertain times were able to share the joy/relief of getting those results and were ultimately the ones who helped usher my daughter into this crazy world.

When my daughter arrived in early May during the height of the first wave of Covid, I was fortunate to be able to have an incredible delivery experience with my care team at the Ottawa Birth Centre. Given the ongoing restrictions in place to limit the spread of the virus, both in hospital institutions and in the community at large, the promise of a trusted and familiar presence throughout my labour and delivery experience was absolutely invaluable, especially given everything we’d been through to ensure the birth of a normal, healthy baby. In addition, because of travel restrictions, my mother was not able to come to Canada for the birth of my daughter, which was terrifying for me as a first-time mom. Yet again, my midwives stepped in, not just as impeccable care providers, but also as friends and family members to give encouragement/support and to share in the joy of my daughter’s birth. This also came with the peace of mind that both of my attending midwives had hospital privileges, and if anything went awry, my preferences for continued midwifery care would be respected. Without these privileges, had anything occurred necessitating a hospital transfer, I can honestly say the lasting emotional effects of being transferred from their care would have been significant. I have nothing but respect for OBs, but my midwives legitimately changed my life.

Given that increasing numbers of pregnant people are requesting midwifery care, I humbly urge you to consider extending and expanding hospital privileges for these incredible care providers so more qualified midwives can be hired to ensure that no one is turned away.

I appreciate your attention to this urgent matter and look forward to your response.

Best regards,
Kim Lopshire-Fitton

Dear Dr. Mark Walker, Dr. Virginia Roth and Mr. Cameron Love,

As a former midwifery client, I would like to advocate for the expansion of permanent midwifery privileges at The Ottawa Hospital. I am troubled to know that there are people currently on waitlists for midwifery care who will not be able to have a midwife due to restrictions on midwifery hospital privileges. These restrictions impact the ability of birthing people in Ottawa to have both their care provider and birth place of choice.

In April 2019, the Champlain Maternal Newborn Regional Program released a Region-Wide Maternal Newborn Health Services Capacity Plan – Phase 1 that outlines our community’s needs for maternal newborn health services. One of the ten recommendations identified in this report, recognizing that demand for midwifery care in this region surpasses its availability, calls for “midwifery privileging processes at each hospital [to] be reviewed and opportunities to increase the number of midwifery supported births at OBWC should be explored.”

I am grateful to have received excellent midwifery care during two pregnancies and births in Ottawa (2014 and 2017). In both cases, I chose to have home births, with the confidence that if a hospital transfer had been required, my chosen care providers would have been authorized to accompany me with full privileges. The positive impact of continuity of care on maternal and neonatal outcomes has been well documented and The Ottawa Hospital should be striving to expand permanent access to midwives rather than making midwifery privileges more precarious.

I look forward to hearing from you on this important issue.

Sincerely,

Norah Lynn Paddock

Dear Dr. Mark Walker, Dr. Virginia Roth, Dr. Khadija Boulaftali, and Mr. Cameron Love:

Midwifery consumers and advocates are asking, yet again, for more midwives to be privileged at The Ottawa Hospital. This request is based on the community need. All practices have wait-lists for care, and in order for the practices to be sustainable and serve clients though pregnancy, birth and the early postpartum period, more midwives with hospital privileges are needed. Failure to increase the numbers of midwives privileged at The Ottawa Hospital disrupts continuity of care, choice of birthplace and the autonomy of birthing people, which are tenets of midwifery care.

Continuity of care with a trusted care provider enhances feelings of safety which in turn provides more positive outcomes, because the client’s autonomy and values are respected. When there is no midwife with hospital privileges available, midwifery clients are forced to transfer care to the obstetrician on call (non-urgent transfers). Without increase, the capacity to provide care to midwifery clients is jeopardised and there is a risk that midwives will not be able to provide care to those already on their caseloads. Having midwives transfer their care to other midwives who are unknown to the birthing person is not a solution. Midwifery clients choose midwifery in part because the person who will attend their births is someone who has gotten to know them and can provide care based on knowledge of their needs and history. Many midwifery consumers would not want to transfer care to an unknown midwife because of the importance of the continuity of the care relationship — not only with unknown midwives, but with specific, known, care providers.

In addition, choice of birthplace is taken away from birthing people when birthing people are prevented from maintaining continuity of care with their known midwife. When birthing people are forced to choose between birthing in the hospital and maintaining their care provider of choice (licensed midwife without hospital privileges), this puts the birthing person, the midwife who must transfer care and the obstetrician on-call who receives these non-urgent transfer of care in a position they do not want to be in. The solution is simply to provide more midwives with privileges, and allow them to practice to their full scope of practice (which includes but is not limited to twins, VBACs, VBA2C, and breech).

Supporting birthing people in maintaining continuity of care with their trusted midwife makes it easier for birthing people to accept urgent transfers of care. A forced (non-urgent) transfer of care, due to hospital policy, when midwifery care could be made available, sets up a power-dynamic that signals to birthing people that the preferences of the hospital supersede birthing people’s needs for person-centred care that reflects their values. This erodes trust in the hospital system and in obstetrics. Loss of choice and autonomy are heightened during COVID-19. These are risk factors for negative emotional outcomes in childbirth, including trauma.

Individually, clients have been advocating to The Ottawa Hospital for respect for birth choices and midwives’ full scope of practice since prior to 2006. We have been mobilising since prior to the 2009 Ottawa Breech Conference, with repeated requests for access to midwives’ full scope of practice, since 2013. These are not individual cases, but a systemic practice by hospitals and their administrators to limit the choices and rights of birthing people. We want respect for our autonomy, which includes access to midwifery care within their full scope of practice. We ask that the Administration at TOH work with the midwives to resolve this situation as quickly as possible by privileging more midwives to address community needs and granting full scope of practice to all midwives privileged at their hospitals.

Sincerely,

Céline Ouellette, Mothers of Change of the National Capital Region

Jenya Levin, Consumers Supporting Midwifery Care

Julia Driedger, Consumers Supporting Midwifery Care / Past midwifery client six times

Margaret Crothers-Beaulieu, The Coalition for Breech Birth

Nancy Salgueiro, The Informed Choice Coalition

Robin Guy, The Coalition for Breech Birth

Wendy Jolliffe, Choice! A Birth and Baby Film Festival (ICC)

cc: Ola Levitin, Registered Midwife, Community Midwives of Ottawa;
Midwifery Collective of Ottawa;
Ottawa South Midwives;
Kelly Dobbin, Registrar / CEO, College of Midwives of Ontario;
Juana Berinstein, Interim Executive Director, Association of Ontario Midwives

Dear Dr. Mark Walker, Dr. Virginia Roth and Mr. Cameron Love,

As a midwifery client, I would like to advocate for the expansion of midwifery services in hospital. I am troubled to know that there are people currently on waitlists for midwifery care who will not be able to have a midwife due to restrictions on midwifery hospital privileges. As a proportion of these people will give birth out of hospital and at the birth centre, these restrictions impact choice of birthplace, as well as choice of care provider.

CMNRP recently released a Capacity Plan outlining the needs of our community and identified that “given women in the region requested increased access to midwifery services, midwifery privileging processes at each hospital should be reviewed and opportunities to increase the number of midwifery supported births at OBWC should be explored” :

http://www.cmnrp.ca/en/cmnrp/Capacity_Plan_Final_Report_2019_p4924.html

I look forward to hearing from you on this important issue.

Sincerely,
Mai Ngo

Dear Dr. Mark Walker, Dr. Virginia Roth and Mr. Cameron Love,

As a midwifery client of Community Midwives of Ottawa, I would like to advocate for the expansion of midwifery services in hospital. I am troubled to know that there are people currently on waitlists for midwifery care who will not be able to have a midwife due to restrictions on midwifery hospital privileges. As a proportion of these people will give birth out of hospital and at the birth centre, these restrictions impact choice of birthplace, as well as choice of care provider.

I gave birth in June under the care of Martha Naime Velasquez, who is an internationally trained physician and midwife. Martha is an absolutely wonderful, kind, compassionate and knowledgeable midwife who provided me with a fantastic prenatal and labour/delivery experience. Prior to Covid-19 outbreak, I had planned to give birth at the Ottawa Civic Hospital under Martha’s care. In April, after a month of worrying and isolation due to the pandemic, I changed my birth plan to deliver at the Ottawa Birth Centre, as I felt safer and more in control of my health doing an out of hospital birth. This being said, at 35 weeks pregnant, I found out that my baby was in the breech position. Luckily, my baby flipped and I was able to deliver at the Ottawa Birth Centre – which was an absolutely wonderful experience. It is important to note that I was greatly reassured that if my baby didn’t flip in time OR if there was a complication during delivery requiring an immediate transfer, that I would be able to continue to receive Martha’s care, should I need to deliver at the Ottawa Civic Hospital.

Based on my experience, I feel that it is extremely important that qualified and experienced midwives, like Martha, are granted/reinstated the proper privileges to practice in-hospital as well. The continuance of care during pregnancy through delivery is so crucial. It is my hope that many women are able to have the experience that I had, with the freedom to choose their birthplace out of all the options (hospital, home or birth centre), as patients of registered midwives.

CMNRP recently released a Capacity Plan outlining the needs of our community and identified that “given women in the region requested increased access to midwifery services, midwifery privileging processes at each hospital should be reviewed and opportunities to increase the number of midwifery supported births at OBWC should be explored” :

http://www.cmnrp.ca/en/cmnrp/Capacity_Plan_Final_Report_2019_p4924.html

I look forward to hearing from you on this important issue.

Sincerely,
Allie Burke

Dear Dr. Walker, Dr. Roth, and Mr. Love,

Almost 20 years ago, I gave birth to my first child, at home, with the loving support of my husband and best friend, under the care of my midwives. It was the most incredible experience of my life. I was so grateful to be able to labour at home, to be safely delivered of my baby, and to snuggle up with her in my own bed. She was born at lunchtime, and my husband ordered pizza and we chatted and laughed in amazed wonder at what had just happened. This happy memory was only possible because my midwives had hospital privileges.

All three of my children were born at home, and I received excellent care from the midwives and obstetricians that I saw during the course of my pregnancies. I was so impressed by the collegiality and respect. The expectant families of Ottawa are very fortunate to have access to a range of birthing options. Every woman should be able to labour and give birth where she feels safe and cared for, whether that is the hospital, the birth centre, or, as it was for me, at home.

At the time that I was having my babies, waiting lists were such that I would take a home pregnancy test on the day that I expected my cycle to start to make sure I got a spot. My friend waited until she missed a period after a suspiciously light period and she ended up on a waiting list. My understanding is that twenty years later there are still waiting lists long enough that women who wanted midwifery care were unable to access it.

Please consider making permanent the hospital privileges of the midwives who currently have temporary privileges.

Best regards,
Nathalie Schiebel
past client of The Midwifery Collective of Ottawa
mother to Lara (b. February 2001), Josephine (b. November 2002) and Kieran (b. October 2004)

Dear Dr. Mark Walker, Dr. Virginia Roth and Mr. Cameron Love,

As a midwifery client, I would like to advocate for the expansion of midwifery services in hospital. I am troubled to know that there are people currently on waitlists for midwifery care who will not be able to have a midwife due to restrictions on midwifery hospital privileges.

I have 3 children all delivered by a midwife in 3 different cities. My experience with midwifery hospital privileges in Ottawa is deplorable. During my time giving birth in hospital, my midwife spent so much of her time filling out required paperwork and checking off boxes, leaving very little time for patient care. The midwife was also treated with indignance and disrespect by the OB/GYN on call, as if the midwife were unworthy of hospital privileges. One of my children was born in the United States. Although a birthing centre was available, I opted, once again for a hospital birth. In hospital, I had a nurse assigned to me as well as my attending midwife. I watched as midwife and nurse interacted and worked together side by side in a supportive and respectful manner, delivering my baby together.

Never should a midwife be treated as less by any colleague in the medical profession. My 3 midwife experiences, but especially my first here in Ottawa, were exceptional. I would encourage any woman to receive pre and post natal care from a midwife.

CMNRP recently released a Capacity Plan outlining the needs of our community and identified that “given women in the region requested increased access to midwifery services, midwifery privileging processes at each hospital should be reviewed and opportunities to increase the number of midwifery supported births at OBWC should be explored” :

http://www.cmnrp.ca/en/cmnrp/Capacity_Plan_Final_Report_2019_p4924.html

I look forward to your response regarding this extremely important issue.

Sincerely,
A midwifery consumer