Week 4: Choice of Birthplace & Appropriate Use of Technology Flashcards
What are the CMO active practice requirements?
- (a) over a one-year period, to at least 20
[clients], 10 of whom the member attended as
primary midwife with at least five births
occurring in a hospital and at least five in a
residence, remote clinic or remote birth
centre; or - (b) over a two-year period, to at least 40
[clients], at least 20 of whom the member
attended as primary midwife with at least 10
births occurring in a hospital and at least 10
in a residence, remote clinic or remote birth
centre.
What document outlines the registration requirements/active practice requirements?
midwifery act 1991
What percentage of midwifery clients choose to have their babies at home?
20
What is a level of hospital is a homebirth equivalent to?
Level 1 in terms of monitoring,
medications and medical equipment
What elements make homebirth safe?
- Training and education of midwives related to homebirth – out-of-hospital birth numbers,
emergency skills training (NRP, ESW, CPR) - Medications and equipment
- Screening for low-risk client
- Planned
What is the research evidence behind a planned homebirth?
- Lower rates of c/s and assisted vaginal birth for planned home births in both primiparous (first baby) and multiparous clients
- Fewer intrapartum interventions
- No higher risk of neonatal mortality at home or in hospital
- Neonatal outcomes same between hospital and home birth
How many hospitals do midwives work in across the province?
124
What percent of midwifery clients choose hospital births?
75
What percentage if midwifery clients end up having a hospital birth?
80
Are midwives required to have hospital privileges?
yes!
Why are hospitals the appropriate choice for women with risk
factors for complications?
- Capacities to provide and/or organize care
for high-risk pregnancies and maternal or
neonatal complications - Interprofessional collaboration
- Hospital policies and restrictions
- Increased rates of interventions
Who funds birth centres?
Ministry of Health and Long-term care
Who regulates birth centres?
CMO
What framework was used to develop birth centres?
Indigenous framework with the aim to create a culturally safe space for families to give birth
What is the level of client satisfaction in birth centres?
High level! 84% stating they would plan to give birth in a birth centre again
What is Tsi Non:we Ionnakeratstha
Ona:grahsta:
The place they will be born
* Opened in 1996 and led by Indigenous midwives
* Six Nations of the Grand River Territory (Haudenosaunee confederacy – Cayuga,
Mohawk, Oneida, Seneca, Onondagas and Tuscarora)
* Full-service maternal and child health centre and birthing centre
When did the Toronto and Ottawa birth centres open
2014
When are people admitted to the Toronto Birth Centre and Ottawa Birth and Wellness Centre
Active labour
what are the pain options at T and O birth centres?
- Pain relief options include TENS (Transcutaneous Electrical Nerve Stimulation),
Nitrous Oxide, Suspended Sling - Large birth tubs are available
Are there doctors or nurses on site at T and O birth centres?
no
How long after delivery are people discharged from T and O birth centres?
3-4 hours
* Transfer to hospital in either emergent or non-urgent scenarios through EMS or
self provided transport
When was Guide to Effective Care in Pregnancy and
Childbirth published and by who?
First published in 1989 by Dr. Murray Enkin
What was included in Guide to Effective Care in Pregnancy and
Childbirth
Included practices that were known to be
beneficial, harmful, or unknown in
pregnancy and birth
What view on birth did Guide to Effective Care in Pregnancy and
Childbirth create?
- Created a holistic view of what birth
might look like - Promoted the idea that restrictive
interventions should only be used when
they do more good than harm
What are some examples of reproductive technology
Medications
Fertility technologies
Genetic screening
Genetic testing
Ultrasounds
Number and type of lab tests
Artificial rupture of membranes
Induction/Augmentation of labour
Continuous electronic fetal monitoring
Assisted vaginal delivery
Cesarean section
What is the harm of reproductive technology?
- Increased risks associated with the pregnancy
- Client/patient dissatisfaction with experience of
pregnancy and birth - Promotion of fear and anxiety
- Cascade of interventions
- Increased risk of caesarean or assisted vaginal delivery
- Risk of pathology, nosocomial* complications
How do we know that the use of
technology is appropriate?
- Rigorous and robust research evidence
- Clinical guidelines
- Clinical indication
- Identification of the risk of intervention vs the risk of no
intervention - Examination of alternatives
- Minimal intervention with the natural physiology of
pregnancy and birth - Informed choice
What is the benefit of appropriate use of technology in midwifery care?
- Provision of holistic care combining traditional midwifery practices and
obstetric knowledge - Support the families and individuals values, rituals and preferences
surrounding birthing - Attend to the social, emotional, spiritual and psychological needs of the
pregnant and labouring person - Increased client satisfaction with experience and care
- Fewer interventions and related complications
- Increased time with the client for hands-on care encouragement and
support - Increased job satisfaction
- Reduced health care costs
What is the Importance of Evidence Based Practice?
- To guide clinical practice and decision making
- To support physiologic birth
- Advocacy for midwives and clients
