model of midwifery practice college of midwives of british columbia
Informed Choice
The College of Midwives' Philosophy of Midwifery Care states:
"Midwifery promotes decision-making as a shared responsibility between the woman, her family (as defined by the woman) and her caregivers. Midwives recognize women as primary decision-makers."
Midwives respect the right of women to make informed choices and facilitate this process by providing complete, relevant, objective information in a non-authoritarian, supportive manner. Having adequate time for discussion in the prenatal period is necessary to the successful facilitation of informed choice. Normally, antenatal and postnatal visits last approximately 45 minutes.
Midwives support the principle of informed choice by:
Promoting shared responsibility between the woman, her family and her caregivers while recognizing and supporting the woman as the primary decision-maker;
Encouraging the woman to participate actively in their care and to make choices about the services she will receive and the manner in which her care is provided;
Discussing the scope and limitations of midwifery care with the woman; and
Allowing adequate time for discussion in the prenatal period.
Choice of Birth Setting
Midwives respect the right of the woman to make an informed choice about the setting for birth. Midwives must be competent and willing to provide care in a variety of settings, including homes, hospitals and birth centers, where available. Midwives must have hospital privileges and be able to function within their full scope of practice in both the home and hospital setting. The ability to attend to the woman in her choice of birthplace is an essential aspect of continuity of care and informed choice. Midwives provide the information required to make an informed choice about appropriate settings in which to give birth. The birth setting is chosen by the woman in consultation with the midwife.
Establishing choice of birth setting as a fundamental component of midwifery practice is essential to providing women with equitable access to care in their chosen place of birth. This is particularly important in rural and remote communities where it is unlikely that women will have access to a choice of midwives.
Second Midwife or Qualified Birth Attendant
The Canadian standard of care is to have two skilled attendants at every birth. The safest care can be provided when there are two qualified persons present at a birth, each skilled in neonatal resuscitation and in managing maternal emergencies. Each birth, particularly those occurring in an out-of-hospital setting, should be planned with the understanding that two midwives will be in attendance.
When it is not possible to have a second midwife in attendance, reasonable efforts must be made by the principal midwife to secure the assistance of a suitably qualified second attendant prior to the birth. The second birth attendant must be skilled in neonatal resuscitation and in handling maternal emergencies.
Qualified second birth attendants may include registered nurses, physicians, or other health care practitioners who have the knowledge and skills required to assist the midwife with the birth, in accordance with the midwifery model of care. Arrangements for using a second birth attendant must be approved by the College.
Collaborative Care
Midwives collaborate with other professionals to ensure their clients receive the best possible care. Collaborative care involves cooperation and consultation with other health care professionals in the provision of care. Collaboration with other health care providers occurs with informed choice and in the best interests of the woman and her newborn.
Accountability and Evidence-based Practice
Midwives' fundamental accountability is to the woman in their care. They are also accountable to their peers, their regulatory body, the health agencies where they practice, and to the public, for safe, competent, ethical practice. Midwifery practice will incorporate evaluation that includes ongoing community input and participation in current mortality reporting standards and review processes. Results of these evaluations must be widely distributed to influence policy, education, and practice. Midwives will continue to develop and share midwifery knowledge, promoting and participating in research regarding midwifery outcomes.
