Midwives in Ontario follow three main tenets of care as set out by the College of Midwives of Ontario. These fundamental principles are informed choice, choice of birthplace, and continuity of care.
Informed choice is a collaborative information exchange between midwife and client that supports client decision-making. Midwives recognize the client as the primary decision-maker and facilitate the collaborative process of informed decision-making by:
- Fostering a relationship of trust and respect between midwife and client
- Providing relevant information in a collaborative and non-authoritarian manner
- Considering the experiences, feelings, beliefs, values, and preferences of the woman
- Making recommendations relevant to the client’s individual care
- Making a best effort to ensure the client fully understands all relevant information prior to making a decision
- Allowing adequate time for decision-making by the client
- Supporting the client’s decision
Choice of Birthplace
Midwives recognize clients as primary decision-makers in their health care and support them in choosing the most appropriate setting for their birth. Midwives provide clients with the necessary information required to make informed decisions regarding place of birth.
The literature on Ontario homebirths demonstrates that planned homebirth with a well-screened population of women, within a supportive health care system, and attended by professionally trained midwives carrying emergency equipment, are as safe as planned hospital births. The view of birth as a normal physiological process is central to the midwifery philosophy of care. The promotion of normal birth and the reduction of unnecessary interventions are recognized as essential factors to improving maternity care outcomes.
Continuity of Care
Midwives make the time commitment necessary to develop a relationship of trust with the woman during pregnancy in order to provide safe and individualized care. Continuity of care is achieved when a relationship develops over time between a woman a small group of no more than four midwives. Midwifery care is provided by the same small group of midwives from the beginning of care (ideally, at the onset of pregnancy), during all trimesters, and throughout labour, birth, and the first six weeks postpartum. The midwifery practice ensures there is 24-hour on call availability by one of the group of midwives known to the woman. One midwife is identified as the coordinating midwife, responsible for coordinating care and for identifying who is responsible if she is not available. The midwifery practice must arrange for opportunities for the client to meet her assigned midwives to support the provision of care by known midwives.
The standard for continuity of care does not restrict the number of midwives who may work together in a practice. As well, midwives from different practices may occasionally share the care of a client (to help cover holidays, for example).