We offer patients a model of care based on informed choice. Patients make Informed choices based on an understanding of available and relevant information provided by the health care team. You are the primary decision maker in your care.
Maternity CORe practitioners respect your choice of birthplace. Women who are low risk may wish to deliver their baby in hospital or at home. Your choice of birthplace should be discussed with your practitioner. All Maternity CORe practitioners will ensure that you are connected to the appropriate care giver(s) for any home birth choice.
As a patient, you will be welcomed into a shared care team to provide you with continuity of care throughout your pregnancy, birth and postpartum time. Each team includes either a small group of family doctors or registered midwives. One of your team members will always be available 24 hours a day, 7 days a week. This model allows you to become familiar and comfortable with each team member, and allows practitioners to accommodate the possibility of simultaneous births and family emergencies.
Typically, you will see one primary practitioner for each monthly visit up until 28 weeks. After 28 weeks, you will meet with other team members in scheduled appointments. Your labour and delivery will be attended by the on-call team; in nearly all cases it will include one of the team members who have taken part in your prenatal care.
Primary practitioners meet with other team members on a regular basis to review and discuss patients' progress through their pregnancy. Maternity CORe respects each client's right to confidentiality. Only team members will see your records.
Maternity CORe practitioners include both Family Doctors and Registered Midwives. Doctors and midwives work collaboratively to ensure that women and families receive the highest quality care. Both types of practitioners provide similar levels of care to low risk pregnant women and both have equivalent privileges at Toronto East General Hospital.
Registered Midwives and Family Doctors work collaboratively to provide a high level of care to Maternity CORe patients; both specialize in low risk pregnancy and healthy newborn care.
Registered Midwives and Family Doctors share a philosophy of woman-centred care, informed choice, continuity of care and appropriate use of technological intervention.
Family Doctors are governed by the College of Physicians and Surgeons of Ontario and are able to offer a broad range of primary care expertise. Midwives are governed by the College of Midwives of Ontario and receive their license by the province after completing a four-year intensive degree in midwifery. They provide prenatal, intrapartum and postpartum care for mother and baby in hospital or home.
II. Commitment to Research and Evaluation
RESEARCH
The concept of collaborative care between Family Doctors and Registered Midwives is new to Ontario. The first stage of the project's implementation will unite doctors and midwives behind the scenes. The collaboration will initially be through consultation, chart checks, hospital initiatives for low risk maternity care, and shared educational endeavours.
The next stage of the collaboration will involve both professions working in a shared care team to provide direct patient care. This level of collaboration and shared care will provide increased points of access for women and increased growth of community based, primary care services for women and their families.
Maternity CORe is a research endeavour, as such, are committed to evaluating the success of this collaboration. We will ask you to complete a confidential questionnaire. Information will be collected regarding the benefits of shared care teams, both to patients and the health care system at large; numbers of hospital re-admissions after delivery; provider attrition rates; and patient satisfaction. Data collected and analysed will directly influence future policies and procedures in the Maternity CORe program.
EDUCATION
Maternity CORe is also an active participant in obstetrical education for students and medical residents. We are a designated teaching site and participate in the education and supervision of students from family medicine and midwifery programs.
You will meet and get to know the students who are working in our practice during your prenatal care. Students are involved in all aspects of care, including prenatal, labour and birth, and postpartum care, with supervision dependent on their level of study. Your experience with students and their level of knowledge and learning through this program will also be evaluated in the questionairre.
III. About Toronto East General Hospital (TEGH)
All Maternity CORe practitioners all have privileges at TEGH. The newly-opened Family Birthing Centre at TEGH has 23 state-of-the-art rooms for patients to labour, birth, and recover in.
You will need to pre-register with TEGH before 30 weeks gestation. You will be given a Pre-registration Package by your practitioner. Completed forms should be returned to the Maternal, Newborn and Child Reception Desk located in area J7 of the hospital. In addition to the form, you should bring a valid Health Card, Extended Health Benefits Information (if applicable) and Immigration documents (if applicable). More information on pre-registration can be obtained by contacting the hospital directly at (416) 469-6130.
Tours of the Maternal Newborn and Child Centre are held on the 1st Wednesday (at 7:00 pm) and 3rd Wednesday (at 3:00 pm) of every month. The tour guide will meet you at the Coxwell Lobby Information Desk. No charge or registration is required. Tour information is available by calling (416) 461-8272.
Should your baby need special care or observation, TEGH has a Level II Nursery. This Nursery is equipped with 20 Intensive Care Newborn Beds and two Care-by-Parent Rooms. Within the Special Care Nursery parents can become comfortable with the special medical needs of their baby in a safe environment.
IV. Scope of Maternity CORe Care
Our scope of care includes prenatal care, care during labour and delivery as well as postnatal care for you and your healthy baby until six weeks postpartum.
Meaning of Low Risk
Maternity CORe specializes in the provision of low risk maternity care. More than eight-in-ten pregnant women are categorized as low risk. If you are a healthy woman without a history of high risk pregnancies, then you are likely at low risk. It is a myth that women over the age of 35, those with previous caesarean sections and those with minor prenatal illnesses are necessarily high risk. A Maternity CORe practitioner will determine your level of risk. Women with higher risk pregnancies will be referred to an obstetrician.
Prenatal care
All women need adequate prenatal care. You will be an active participant in your care, and will learn about your body's changes as pregnancy advances. Maternity CORe practiioners will monitor blood pressure, fetal growth, fetal heart rate and position, urinalysis and the general health of mother and baby. We will do your blood work and any other relevant testing during the prenatal period. Practitioners will take time to address your concerns and answer your questions.
If clinically indicated, Maternity CORe practitioners will consult with other medical specialists throughout your prenatal care.
We expect to see you at least once a month until the 28th week, every second week until the 36th week, and once a week thereafter. Family and friends are welcomed and encouraged to accompany you to prenatal visits.
Labour and Delivery
You will be provided with detailed information about when and how to contact your practitioner once labour has begun.
Our care throughout labour includes monitoring labour progress and the well being of both you and your baby as well as providing support. One of the Maternity CORe team members who is familiar to you will deliver your baby.
Transfer of Care
In the event that either your pregnancy or labour evolves into a higher risk situation, your care may need to be transferred to a specialist.
Transfer of care can take many forms. Sometimes this transfer is temporary, meaning that at some point the clinical responsibility will be transferred back to your family physician or midwife. In other situations, transfer of care is for the entire duration of you and your baby's care. Sometimes transfer of care comes before your labour as with an induction for post dates. Other times, the transfer of care comes shortly before your actual birth. Your Maternity CORe practitioner will discuss the reasons for the transfer of care and the type and amount of support you need during any transfer of care situation.
If the primary care is transferred to the specialist from your Maternity CORe pracititioner, the specialist will assume complete and full responsibility for subsequent decision making and your care. In this situation, your Maternity CORe practitioner does not provide any more clinical care for you and/or your baby. However, they will be available to you for support.
The Department of Family Practice/Division of Midwifery along with the Department of Obstetrics and Gynaecology and Department of Paediatrics worked together to develop the Consulation and Transfer of Care Policy which is currently used for all family practice and midwifery practitioners at the Toronto East General Hospital.
Common Reasons for Transfer of Care
- Induction of Labour for Overdue Babies
Normally, babies come at 40 weeks of pregnancy. However, most times a baby is not born on the exact due date given. This is why we call it an 'estimated date of birth' (EDB). Some studies have suggested that babies born after 42 weeks of pregnancy don't do as well, and therefore, at your 39 or 40 week appointment, your Maternity CORe practitioner will talk to you about having an induction of labour before 42 weeks.
The policy at Toronto East General Hospital for post-dates pregnancies is to induce labour approximately 10 days after the EDB, that is, between 41 and 42 weeks of pregnancy. The induction of labour is ordered by an obstetrician and requires a transfer of care.
The usual procedure is for a date to be booked on which you will be induced. On induction day you will go to the hospital and be seen by the obstetrician on call. The obstetrician will explain to you some of the ways in which he or she would like to try and induce your labour.
Although the specialist and the nurse will provide your clinical care during labour, your midwife or family physician will be available to you for support. You will see your family physician or midwife sometime soon after the induction has started, and periodically throughout the day. They are also on call for any questions that you might have when they are not with you. When you are ready to deliver your baby, your family physician or midwife will be there to support you and to take care of your healthy newborn.
- When Active Labour Stops
If your labour stops or is not progressing well, your Maternity CORe practitioner will consult with the obstetrician on-call and ask for an augmentation for your labour. This usually involves oxytocin given to you by an intervenous "drip" as with a conventional induction. This is a transfer of care. The role of the nurse and the obstetrician during an augmentation is the same as with an induction.
- Paediatric Care
If your new baby requires any special clinical attention, the family physician or midwife will consult with a paediatrician. Once the consultation has occurred, it will be determined if the family physician or midwife will continue caring for your newborn or transfer of care to the paediatrician.
Postnatal Care
After the birth of your baby, Maternity CORe practitioners will care for you and your new baby until 6 weeks post partum. Postnatal instructions including breastfeeding advice, emotional support and guidance are given to you after the birth. Maternity CORe practitioners will also help to connect you with other community agencies and services if needed.
Postnatal visits are scheduled with one of your Maternity CORe team following the birth. At 6 weeks, a final assessment of both you and your baby is made. At this time we also discuss family planning. Care of you and your newborn is transferred back to your original primary care provider at approximately 6 weeks post partum. If you do not currently have a primary care provider, appropriate referrals will be made for you.
V. Linkage to Support Programs
Maternity CORe offers links to a wide variety of support programs, including prenatal classes, doula services, a breast feeding resource clinic and nutritional education.
VI. Specialist Consultation
In the event that your midwife or family physician identifies a clinical situation which is outside of their scope of practice they will contact a specialist who will make recommendations regarding that particular clinical issue.
This consultation involves an appointment with the specialist. However, where urgency, distance, or other conditions make an in-person consultation with the specialist not possible, the midwife or family physician will seek advice from the specialist by telephone.
Once the consultation with a specialist has taken place and the consultant's findings have been communicated to you, the family physician or midwife will discuss these recommendations and ensure that you fully understand them.
Sometimes the consultant or specialist may be involved and responsible for a discreet area of your care with your midwife or family physician maintaining the overall responsibility within his or her scope of practice. Sometimes the consultation requires a full transfer of clinical care to the specialist.
VII. Parent's Role and Responsibility
Maternity CORe practitioners provide individualized care according to your needs. It is important for you to actively communicate with your practitioners and keep them well informed of problems or situations that may affect your care.
Parents are responsible for the health of both themselves and their babies. You should follow a balanced diet, participate in good prenatal care and get adequate sleep and exercise.
Parents will also need to acquire the knowledge and skills necessary for labour and birth, either through prenatal classes or self-education.
VIII. Health Care Coverage
The Ontario Hospital Insurance Plan (OHIP) and the Ministry of Health and Long Term Care provides full coverage for all prenatal, intrapartum and postnatal care provided by Maternity CORe practitioners. There is no additional charge for maternity care or hospital charges for those covered by OHIP.
Maternity CORe is able to make some accommodations for patients without OHIP coverage. Please discuss these issues with your practitioner.
Extended Health Care Plans may cover the additional cost of semi-private rooms at the hospital.
Related maternity services such as doula care and prenatal classes are privately provided and are not covered by OHIP.
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