Midwifery: Vancouver vs Ontario

Midwifery in BC is awesome. It’s awesome in Ontario too, but in BC both antenatal and intrapartum management is different.

A few key differences:

  • Drugs: The pharmacopoeia scope is larger, meaning midwives can prescribe more drugs. Recently, midwifery scope has even been expanded to prescribe narcotics such as morphine. If the midwife takes an extra course, she is able to administer morphine and Gravol without a physician’s order, so that exhausted women in early labour can get some sleep at home.
  • Birth management: different than in Ontario, only one midwife attends a hospital birth in Vancouver. As you come in to the hospital with a client, you are assigned a nurse that will work with you. The nurse takes the maternal vitals throughout the labour, listens to the fetal heart q15 minutes, administers IVs etc. As the midwife, you are responsible for overall management – you watch the labour progress, give labour support, and make decisions about what to do next. The nurse looks to you for next steps. Then, working together with the nurse, you apply your decision. In Ontario, the midwife does both the nursing and the management role. In this regard, Vancouver was more traditionally physician-like, but midwife-led.
  • Home birth: Two midwives still attend home births, however, a second midwife isn’t always required; sometimes, that second attendant can be a certified birth attendant. These are usually labour and delivery nurses who have taken further education to back-up midwives at home births. The clinic I was at had the midwives back each other up, but, other clinics, including solo-practitioners, more frequently use second birth attendants.
  • Lab tests: midwives can order more labs, including thyroid hormone levels and liver function testing. Based on the results of these labs, we have an idea of what is happening and whether or not we need to consult an obstetrician. In ON, midwives have to refer to a family doctor to get these labs done, then if the levels are high, the family doctor and midwife both consult the OB. It seems more circular.
  • Schedule: The midwives at my clinic had a shared-care model with a lovely schedule that allowed for work-life balance. With 5 of them on a team at once, the schedule broke down as follows:
    • 1 midwife on her 1 month off
    • 4 midwives on call rotation:
      • 1 midwife on 24h call (6pm – 6pm)
      • 2 midwives off
      • 1 midwife in clinic

Some combination of the above allowed midwives to be on-call every 4 days or so, and in clinic 1-2 days per week. Sometimes, even if the midwife was off, she let us know if she was available. There certainly was a week where 6 people birthed, so without that support we could not have done it all.

I can’t say I have a preference for midwifery in Vancouver or Ontario yet, I’ll have to wait until I start 4th year to really see the differences. I will say, however, that I loved every moment of my experience and that if I do move back to Vancouver I will love every piece of being a practicing midwife there. Cross your fingers for me that that happens!


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