model of midwifery practice college of midwives of british columbia
Primary Care
A primary caregiver is a practitioner who may be the first point of entry to health services for women seeking pregnancy-related health care. As a primary caregiver, the midwife functions under her own responsibility. For each client, the midwife provides a continuum of midwifery services throughout pregnancy, labour and the postpartum period.
Continuity of Care
Continuity of care is midwifery care provided in accordance with the standards of practice of the College and available during all trimesters of pregnancy, labour, birth and the postpartum period, on a 24-hour on-call basis. This principle is fundamental to the model of practice. Continuity of care is both a philosophy and a process that is facilitated through a partnership between a woman and her midwife/midwives. It requires a time commitment from each midwife that enables her:
To develop a relationship with the woman during pregnancy,
To be able to provide safe, individualized care,
To support the woman during labour and birth,
To provide comprehensive care to the mother and newborn throughout the postpartum period.
Ideally, midwifery services will be provided by the same principal midwives throughout pregnancy, labour, birth and the first six weeks postpartum. Family planning services may be provided up to three months postpartum. The full scope of midwifery care will be provided, including education, counseling, advocacy and emotional support.
Although continuity of care is usually facilitated by a one-to-one or a one-to-two relationship between a woman and her midwife/ midwives, continuity of care can be achieved by a small group of no more than four midwives, as long as all members of the group share a common philosophy and a consistent approach, and meet together regularly to coordinate care. The woman must have the opportunity to establish a relationship with the midwives providing her care. A principal midwife responsible for coordinating the care will be identified. A second midwife should be identified as the midwife who would normally take over this role if the principal midwife is unavailable. In exceptional circumstances, a third midwife from the group may attend the birth as the principal midwife.
The principal and second midwives would normally be responsible for providing the majority of prenatal and postnatal care and for attending the birth, assisted if necessary by other midwives in the group. The midwifery practice will ensure there is 24-hour on-call availability of one of the midwives known to the woman.
In situations where transfer of care to a physician is required during labour, the midwife is expected to continue to provide supportive care after transfer and may resume primary care if appropriate. Supportive care involves education, counseling and advocacy throughout the course of care. This also includes labour support and assistance with infant feeding.
