Consumers Supporting Midwifery Care

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