8. Country Information
Canada Netherlands
• Population: 33.8 16.7 million
• Median age: 41 41 years
• Annual births: 368 185 thousand
9. Birthing Information
Canada Netherlands
• Fertility rate: 1.6 1.7 per 1000 women
• Birth Rate: 10.3 10.3 per 1000
• Infant mortality: 5 4.7 per 1000 births
10. Maternity care in Canada
• Increasingly obstetricians doing primary care
obstetrics
– 1996: 56% Vaginal Births by OB
– 2000: 61% Vaginal Births by OB
• Large shift of GP physicians out of obstetrics
– 1989 31%
– 1999 19%
11. Midwifery care in Canada
• More midwives educated and registered
– First regulated midwifery 1994
– Education 4 year BHSc (Midwifery)
• Now 1,000 midwives in country
12. The Midwifery Model of Care
• Built on principles of:
– woman-centred care
– informed choice
– evidence based practice
– continuity of care provider
– choice of birth place.
Source: Canadian Association of Midwives
13. Like the NL:
– A primary care model of midwifery
– Autonomous care providers
– Care during pregnancy, birth to 6 weeks post
partum
– Community-based; hospital privledges
– Self employed
– Collaborative with specialists
– List of required consultations and transfers of
care
14. Unlike the NL
• All midwives must provide care in all
settings
• Midwives provide care after consultation
and supportive care after transfer of care
in labour
– Enhances continuity of care
15. Continuity of Care
• is an important tenant of midwifery care
– Same midwife or small group (<4) midwives
provide care:
• during all trimesters of pregnancy
• Labour & birth and the postpartum period
• 24-hour coverage
Source: College of Midwives of British Columbia
16. Continuity of Care
Allows midwife to:
– Develop a relationship during pregnancy
– Supportive care in labour and birth
– Provide comprehensive care throughout the
postpartum period
– Enhance safe, individualised care
Source: College of Midwives of British Columbia
17. Continuity of Care
• Midwifery care
includes:
– Family planning
services
– Education
– Counseling
– Advocacy and
– Emotional support
Source: College of Midwives of British Columbia
18. Unlike the NL
• Prenatal care visits 30-45 minutes long
• Case load? Hard to compare
• 2 midwives at the birth
– No kraamverzorgster
19. Unlike the NL
• Many midwives travel longer distances to
attend births
• 30 minute general rule, but…
• Rural births registered with EMS
20. Changes in practice patterns
• Research evidence has led to changes in
care protocols
• Populations of women are different
– Many more first time mothers
– More over weight women
– Older birthing population
21. But are they normal?
• Resulting in changes in :
– Management of PROM
– Rates of induction for post dates
– More slow to progress labours
– GBS management protocols
22. Canadian midwives provide care in
“grey areas”
– Broader scope of screening tests;
– Broader pharmacopeia;
– Labour Induction and augmentation;
– Women with epidural analgesia;
– Electronic fetal heart monitoring
23. Canadian midwives provide care in
“grey areas”
– Resulting in greater continuity of care provider
for women
24. Benefits of Midwifery Care
• Cochrane review of continuity of care
models shown to decrease CS
• Vaginal deliveries are associated with a
lower risk of maternal morbidity and
infection and shorter hospital stays.
Hodnett E. Cochrane Systematic Review 2006:1
28. Ontario
Sample Selection
25, 720 births
Planned at the onset of labour
6692 homebirth 6692 hospital birth
29. Ontario
• Of all planned homebirths:
– 78% actually delivered at home
• (60% nullip; 89% multip)
– 5% transported by ambulance to hospital
during or immediately following birth
30. Ontario
Primary outcome - composite of
neonatal/perinatal mortality or serious
morbidity:
– no difference between the home and hospital
2.4% vs. 2.9% RR 0.83 [ 0.67, 1.02 ]
– Both groups reported a perinatal / neonatal
mortality rate of 1:1000
31. Ontario
Primary outcome - composite of
neonatal/perinatal mortality or serious
morbidity:
– no difference between the home and hospital
2.4% vs. 2.9% RR 0.83 [ 0.67, 1.02 ]
– Both groups reported a perinatal / neonatal
mortality rate of 1:1000
32. Ontario
– There were no cases of maternal mortality
– Planned homebirth associated with:
• less serious morbidity 5.5% vs. 7.1%;
RR 0.77 [ 0.67, 0.87 ]
33. Ontario
– There were no cases of maternal mortality
– Planned homebirth associated with:
• less serious morbidity 5.5% vs. 7.1%;
RR 0.77 [ 0.67, 0.87 ]
34. Ontario
– There were no cases of maternal mortality
– Planned homebirth associated with:
• less serious morbidity 5.5% vs. 7.1%;
RR 0.77 [ 0.67, 0.87 ]
• fewer Caesarean section 5% vs. 8%
RR 0.64 [ 0.56, 0.73 ]
35. Ontario
Women planning home birth were less likely
to experience:
• Labour augmentation
– 28% vs. 36%; RR 0.76 [ 0.72, 0.80 ]
• Pharmaceutical pain relief
– 17% vs. 45% RR: 0.37 [ 0.35, 0.39 ]
38. IPE – in education programs
•ALARM for residents
and MW students
•Consultation
workshop
•Introduction to OB for
medical students and
MW students
•Placement with OB,
Nursing
Area of Netherlands is 41,000 sq km. Canada is 214 times larger.
We have many similarities; large cities
But then we have some differences
Total fertility rate: This entry gives a figure for the average number of children that would be born per woman if all women lived to the end of their childbearing years and bore children according to a given fertility rate at each age. The total fertility rate (TFR) is a more direct measure of the level of fertility than the crude birth rate, since it refers to births per woman. This indicator shows the potential for population change in the country. A rate of two children per woman is considered the replacement rate for a population, resulting in relative stability in terms of total numbers
Total fertility rate: This entry gives a figure for the average number of children that would be born per woman if all women lived to the end of their childbearing years and bore children according to a given fertility rate at each age. The total fertility rate (TFR) is a more direct measure of the level of fertility than the crude birth rate, since it refers to births per woman. This indicator shows the potential for population change in the country. A rate of two children per woman is considered the replacement rate for a population, resulting in relative stability in terms of total numbers
Midwifery is built around the principles of ….like the Netherlands we are: autonomous care providers, entrepreneurs providing prenatal post partum etc.
Midwifery is built around the principles of ….like the Netherlands we are: autonomous care providers, entrepreneurs providing prenatal post partum etc.
For the so called grey areas Pharmacopeiaeg. Treatment of bladder infection; IV antibiotic for GBS prophylaxis
For the so called grey areas Pharmacopeiaeg. Treatment of bladder infection; IV antibiotic for GBS prophylaxis
For the so called grey areas Pharmacopeiaeg. Treatment of bladder infection; IV antibiotic for GBS prophylaxis
For the so called grey areas Pharmacopeiaeg. Treatment of bladder infection; IV antibiotic for GBS prophylaxis
Primary Outcome: Composite measure of neonatal/perinatal mortality or serious morbidity:Any stillbirth or neonatal death (≤ 28 days)The presence of any one of the following complications:Apgar < 4 at 5 minutesNeonatal resuscitation (PPV + compressions)Birth weight < 2500gNICU stay of > 4 days
Primary Outcome: Composite measure of neonatal/perinatal mortality or serious morbidity:Any stillbirth or neonatal death (≤ 28 days)The presence of any one of the following complications:Apgar < 4 at 5 minutesNeonatal resuscitation (PPV + compressions)Birth weight < 2500gNICU stay of > 4 days
Secondary Outcome: Composite measure of maternal mortality or serious morbidityAny direct obstetrical cause maternal deathThe presence of any one of the following complications:Blood loss >1000 ml or consultation for bleedingAny infection requiring consultationAny 3rd or 4th degree lacerationAny postpartum transfer of care to a physician
Secondary Outcome: Composite measure of maternal mortality or serious morbidityAny direct obstetrical cause maternal deathThe presence of any one of the following complications:Blood loss >1000 ml or consultation for bleedingAny infection requiring consultationAny 3rd or 4th degree lacerationAny postpartum transfer of care to a physician
Secondary Outcome: Composite measure of maternal mortality or serious morbidityAny direct obstetrical cause maternal deathThe presence of any one of the following complications:Blood loss >1000 ml or consultation for bleedingAny infection requiring consultationAny 3rd or 4th degree lacerationAny postpartum transfer of care to a physician
With collaboration and interprofessional approach we can make a difference to women around the world.
Advances in labour and Risk Management; management of risk effectively for OB;
Advances in labour and Risk Management; management of risk effectively for OB;
