Week 4: Choice of Birthplace & Appropriate Use of Technology

Question 1

What are the CMO active practice requirements?

Answer 1

• (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.

Question 2

What document outlines the registration requirements/active practice requirements?

Answer 2

midwifery act 1991

Question 3

What percentage of midwifery clients choose to have their babies at home?

Answer 3

20

Question 4

What is a level of hospital is a homebirth equivalent to?

Answer 4

Level 1 in terms of monitoring,
medications and medical equipment

Question 5

What elements make homebirth safe?

Answer 5

• 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

Question 6

What is the research evidence behind a planned homebirth?

Answer 6

• 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

Question 7

How many hospitals do midwives work in across the province?

Answer 7

124

Question 8

What percent of midwifery clients choose hospital births?

Answer 8

75

Question 9

What percentage if midwifery clients end up having a hospital birth?

Answer 9

80

Question 10

Are midwives required to have hospital privileges?

Answer 10

yes!

Question 11

Why are hospitals the appropriate choice for women with risk
factors for complications?

Answer 11

• 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

Question 12

Who funds birth centres?

Answer 12

Ministry of Health and Long-term care

Question 13

Who regulates birth centres?

Answer 13

CMO

Question 14

What framework was used to develop birth centres?

Answer 14

Indigenous framework with the aim to create a culturally safe space for families to give birth

Question 15

What is the level of client satisfaction in birth centres?

Answer 15

High level! 84% stating they would plan to give birth in a birth centre again

Question 16

What is Tsi Non:we Ionnakeratstha
Ona:grahsta:

Answer 16

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

Question 17

When did the Toronto and Ottawa birth centres open

Answer 17

2014

Question 18

When are people admitted to the Toronto Birth Centre and Ottawa Birth and Wellness Centre

Answer 18

Active labour

Question 19

what are the pain options at T and O birth centres?

Answer 19

• Pain relief options include TENS (Transcutaneous Electrical Nerve Stimulation),
  Nitrous Oxide, Suspended Sling
• Large birth tubs are available

Question 20

Are there doctors or nurses on site at T and O birth centres?

Answer 20

no

Question 21

How long after delivery are people discharged from T and O birth centres?

Answer 21

3-4 hours
* Transfer to hospital in either emergent or non-urgent scenarios through EMS or
self provided transport

Question 22

When was Guide to Effective Care in Pregnancy and
Childbirth published and by who?

Answer 22

First published in 1989 by Dr. Murray Enkin

Question 23

What was included in Guide to Effective Care in Pregnancy and
Childbirth

Answer 23

Included practices that were known to be
beneficial, harmful, or unknown in
pregnancy and birth

Question 24

What view on birth did Guide to Effective Care in Pregnancy and
Childbirth create?

Answer 24

• 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

Question 25

What are some examples of reproductive technology

Answer 25

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

Question 26

What is the harm of reproductive technology?

Answer 26

• 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

Question 27

How do we know that the use of
technology is appropriate?

Answer 27

• 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

Question 28

What is the benefit of appropriate use of technology in midwifery care?

Answer 28

• 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

Question 29

What is the Importance of Evidence Based Practice?

Answer 29

• To guide clinical practice and decision making
• To support physiologic birth
• Advocacy for midwives and clients