Currently, there are two Ministry of Health funded, and College of Midwives of Ontario regulated, Midwife-Led Ontario Birth Centres. The two sites serve clients in the Ottawa and Toronto regions. The College of Midwives of Ontario has been tasked with regulating these facilities under the Independent Health Facilities Act. As part of our role, the College has developed Facility Standards and Clinical Practice Parameters (CPPs).
Birth Centres align with the Ontario midwifery model of care in that clients in the two communities have a third option in their choice in birthplace. Midwives who provide care in a Birth Centre must have privileges at that Birth Centre – not all midwives in each city have privileges at the Birth Centre. Clients who want to give birth in a Birth Centre must be in the care of a midwife with privileges and meet the criteria set by each Birth Centre.
After a two-year pilot project, the government is funding the two Birth Centres. The government’s stated goal of the Birth Centres (BC) is to provide clients with healthy pregnancies more choice about the care they and their babies receive. Not-for-profit community Birth Centres improve the value of health care by moving uncomplicated births out of hospitals and reducing medical interventions.
The CMO was appointed by the Ministry of Health and Long-Term Care to inspect and assess the Birth Centres three times over the duration of the demonstration project. This process is defined in the Independent Health Facilities Act (IHFA), and is based on processes that have been developed by the College of Physicians and Surgeons of Ontario (CPSO) over the past twenty years. The CMO received advice and input from our CPSO colleagues on the development of this program.
The CMO developed Facility Standards and Clinical Practice Parameters (CPPs); these form the basis of the inspections and assessments.
The inspections and assessments required by the IHFA are very similar to the College’s Quality Assurance assessment program. There will be an added emphasis on the facility in these inspections and assessments, along with clinical care, insofar as the care is in alignment with the protocols of the centre.
No. A Birth Centre in Ontario offers the same level of technology and intervention that is available at a home birth. The Birth Centres are ideal for healthy clients having normal, uncomplicated pregnancies who are planning non-medicated births. Clients of the Birth Centre will be attended by registered midwives along with any support people they wish to bring. Epidurals, inductions, Cesarean sections or other hospital-based services are not available at the Birth Centre.
Ongoing informed choice discussions with clients in pregnancy includes this important information. Clients may be partial to the Birth Centre’s home-like environment (tubs, etc), but it does not fall between home and hospital in terms of availability of resources and equipment. However, research has demonstrated that a physiologic birth (vaginal birth) is more likely in a Birth Centre setting than in hospital.
Choice of birthplace is a central tenet of midwifery care. The Birth Centres offer a third choice to midwifery clients with an uncomplicated pregnancy and early labour. The Birth Centre Board of Directors determines specific criteria, which may exclude a client from giving birth at the BC.
The Birth Centres are a new practice site in Ontario and will have several midwifery practice groups providing care under one roof. Shared protocols are required to ensure uniformity among all caregivers so that care at each Birth Centre is consistent and not provider-dependent. The Birth Centres are midwife-led and all protocols are approved by the appropriate channels at the Board of Director level for each Birth Centre.
Birth Centres have been established as a site for midwifery practise and are midwife-led. Midwives may choose to apply for privileges to the Birth Centre. The BC Board will set the process for acquiring and maintaining privileges.
At this time the Birth Centres may choose to have other services and or health care practitioners provide non-birth care at the BC, for example, lactation consultants, massage therapists, etc. If the BC board decides to have allied programs they need to have procedures in place to ensure that the services do not impact midwifery care in any negative way and that the practitioners are licensed and in good standing by the appropriate regulatory body.
Many elements of the care will reflect how midwifery care is currently planned – midwives book clients through their practice groups; there will be two midwives at every birth; admission to the BC will occur when a client is in active labour; and discharge will occur 4-6 hours postpartum. All aspects of care within the BC are determined through the policies and procedures of each Birth Centre, with approval of the Board of Directors and under the direction of the CPPs.
Yes, there are Birth Centre Aides (BCA) at the Birth Centre 24 hours a day who ensure supplies and readiness of the birth rooms. The BCAs do not assist with births or other clinical aspects and they are not regulated health professionals. Each BC has created a detailed job description for this new role in the Ontario health care system.
Yes, midwives are on call for all of their clients 24 hours a day, including those clients who choose to give birth at the BC. Similar to a hospital birth, the midwife will likely attend to the client at home first and then meet the client at the BC once active labour is established. Clients will not normally meet their midwife at the BC for assessment, unless the midwife feels that labour is progressing too quickly for a home assessment.
The Ministry of Health and Long-Term Care’s request for proposals had a number of required key elements that relate to the structure of the Board of Directors. One, the Board must be 2/3 registered midwives; two, there must be community representation on the board; three, that the BC be a registered not-for-profit organization. Ultimately, the BC is board-governed and the Executive Director of the BC is the connection between the Board and the registered midwives and staff.
Overall, a client may choose to give birth in a Birth Centre because an out of hospital birth is desired and home may not be an option. Some reasons why a client might choose a Birth Centre birth may include: