Hospitals successfully integrate midwives

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The Association of Ontario Midwives (AOM) recently recognized two health care organizations for successfully integrating midwives into their maternity care teams. Markham Stouffville Hospital and Trillium Health Partners received the AOM’s inaugural Hospital Integration Awards.

Midwives have been well-integrated at Markham Stouffville since 1994 when Carol Cameron became the first midwife to provide primary care at a hospital birth under regulation. Cameron was head midwife at the hospital for 18 years, before becoming the clinical manager of the hospital’s childbirth centre (and the first midwife in Ontario to run a birth unit), a position she held for more than two years. Cameron says she and a number of other midwives formed an interdisciplinary hospital integration committee at Markham Stouffville two years before midwifery was regulated in Ontario. To do this day, she says she’s grateful for the support of Dr. Jim MacLean (who was the hospital’s chief of staff 22 years ago and later served as President and CEO), who was very supportive of midwives and midwifery.

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Midwives at Markham Stouffville Hospital work to their full scope of practice including managing oxytocin and monitoring epidurals.  Midwives have also influenced the way physicians and nurses at the hospital practice. “We’ve got other care providers using birthing stools and there are policies on water birth, delayed cord clamping and skin-to-skin. All these things were midwifery-led and now everybody’s doing it,” says Cameron.

Elaine Gouldbourne, the Patient Care Director of Surgical and Maternal Child Services at Markham Stouffville, says embracing the midwifery program enables the hospital to offer more birth options, enhance the patient experience, meet the needs of a diverse population and contribute to a healthier community.

“We recognize that there’s a percentage of our population that has low-risk births and our midwifery partners are very capable of providing that service to our patients. And they have a vital role to play as we continue to expand our program,” says Gouldbourne.

Trillium Health Partners has supported midwives to work to their full scope of practice since its Mississauga Hospital site first privileged midwives in 1994. Trillium has also created midwifery-specific protocols and a Division of Midwifery, and their Head Midwife receives a stipend for her work. In addition, the administration involves midwives in planning, policy development and maternity-care decision making. Head Midwife Aderemi Ejiwunmi (Midwifery Care of Peel and Halton Hills) says the positive work environment that midwives have always enjoyed at Trillium is built on a foundation of mutual respect between the administrators, midwives and other health care providers.

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Ejiwunmi also attributes the integration success to the fact that the hospital has always believed that the midwives should speak for themselves.

“If there was a conflict or challenge or misunderstanding, people were encouraged to speak directly to the midwives and the midwives were supported to explain their own scope of practice, their own approach to care and their own rationale for whatever it was that was being questioned,” says Ejiwunmi.

In the late 1990s, Trillium was one of the pilot sites for MOREOB (Managing Obstetrical Risk Efficiently), a performance improvement program that creates a culture of patient safety in obstetrical units. According to Ejiwunmi, participating in this program helped strengthen the interprofessional relationships and collaboration among colleagues at Trillium by making members of the maternity care team more aware of each profession’s clinical knowledge and giving the midwives, obstetricians and other participants an opportunity to develop social relationships that fostered teamwork.

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Dr. Peter Scheufler, the Program Chief and Medical Director of Women’s Health at Trillium Health Partners, says the midwives have influenced the practice of their interprofessional colleagues and helped the organization meet the needs of women and families.

“I think midwifery has opened up our minds in many ways to augmenting the way that we provide health care to women having babies,” says Scheufler.