MacDonald, M. & Bourgeault, I. (2009). The Ontario Midwifery Model of Care. In Davis-Floyd, R., Barclay, L., Davis, B., & Tritten, J. (Ed.), Birth Models that Work (pp. 89 - 118). Carlifornia: University of California Press.
Canadian Midwifery as a profession was not formally recognized until 1994, when it developed into an autonomous profession for many midwives in Canada. Margaret and Ivy set out to study “Practicing Midwives” in Ontario and the successful integration of midwifery in the province of Ontario from its days as a grassroots social movement to its present status as a full profession. This midwifery model is devoted to offering women-centred, low-tech alternatives to mainstream obstetrical care as such based on the premise that the midwife follows the woman throughout the full course of care from pregnancy to postpartum and attends the birth in the setting chosen by the woman.
The nature of midwifery practice varies across Canada; Ontario being common for local women respected with expertise. In fact two-thirds of Ontario hospitals, births are conducted in the presence of midwives thus presenting midwifery in Canada as social practice embedded in women’s domestic culture in which continuity is highly regarded. However, the distinct improvement and integration of the Ontario midwifery practice skills as compared to other national and regional models was as a result of external factors including international influences. This therefore shows that this model can best be described as both a social movement and professionalization project. Additionally, this model reflects the tenets of continuity of care, informed choice and choice of birth place. However, as members of the public and other health care professionals become more aware of midwifery, this situation is expected to change as integration proceeds, whereby most midwives will have access to all settings thus becoming an effective birth model practice.
Reed, B. & Walton, C. (2009). The Albany Midwifery Practice. In Davis-Floyd, R., Barclay, L., Davis, B., & Tritten, J. (Ed.), Birth Models that Work (pp. 141-158). Carlifornia: University of California Press.
Desperate for change, a group of midwives working together in South East London won the setup money for a groundbreaking midwifery practice. This group, The South East London Midwifery Group Practice (SELMGP) was a community-based project offering a self-managed midwifery service ensuring continuity of care and career to women living in a deprived inner-city area. After a successful outcome and effectiveness in terms of birth delivery and continuous care, it was renamed the Albany Midwifery Practice and became the first group of National health trust in the United Kingdom to successfully negotiate a sub-contract with a health care trust. The Albany Midwifery Practice is a self-employed and self-managed midwifery group practice. It employs seven midwives in partnership, with two practice support workers and serves a non-clinical base providing antenatal, intrapartum, and postnatal care to women for up to twenty-eight days. After successful years of research and experience, Becky and Cathy explain in detail why the use of this practice has achieved excellent outcome for women since 1997. They strongly believe in women’s ability to give birth with minimal assistance. Although the Albany Midwifery Practice and the Ontario Midwifery Model of Care show a continuous practice of midwifery and woman-cantered care, however, the Albany Midwifery team model doesn’t show a high-level of continuity of career, and is associated with levels of burnout for midwives. In developed countries it has been demonstrated that the development of a nation wide system of integrated midwives is the single most important factor in reducing maternal mortality. Consequently, due to a steady increase of home births since 2001, the Albany Midwifery model shows an influence on local birthing culture.
Penwell, V. (2009). Mercy in Action: Bringing Mother and Baby Friendly Birth Centres to the Philippines. In Davis-Floyd, R., Barclay, L., Davis, B., & Tritten, J. (Ed.), Birth Models that Work (pp.337-364). Carlifornia: University of California Press.
Vicki Penwell takes an initiative to study the first women admitted for labour and delivery in two charity birth centres in Philippines from 1993 to 2003. The aim of this research was to identify the mortality as a result to poor midwifery practice in the Philippines, thus prompting the evolution of the Mother Baby model of care. This model of care promotes the health and well-being of all women and babies during pregnancy, birth, breastfeeding, setting the gold standard for excellence and superior outcomes in maternity care. Consequently, from this research it revealed that certain practices in Philippines robbed dignity from the mother giving birth, even with the practice of midwifery. This is because midwives are not prepared with the necessary skills or resources for obstetric emergencies. According to the WHO 2005 World Health Report, the world’s greatest current health need is making motherhood safe and saving the lives of newborns. In light of this great tragedy involving pregnant women and infants, and in light of the global shortage of trained midwives as reported by WHO, Vicki together with her husband Scott and family members, colleagues and friends established teaching birth centres offering no-cost care in low-resource areas in the Philippines. As a result Mercy in Action, Inc. was founded. The non-profit organization operated as a charitable funding source and a training centre for midwives. The Mercy in Action Inc. is also attributed for operating birth centres and medical missions in Philippines. This came in the wake to save lives of many mothers and babies lost because of unskilled midwifery practices in the Philippines. In particular, Penwell talks of great increase in successful births outcomes and suggests that demographically high-risk women can still have good birth outcomes using a model of Mother-Friendly care run by midwives in an out-or-hospital setting in a poor and underdeveloped country such as the Philippines. This brings a strong conviction that all maternity service providers should be educated in, provide, and support the Mother-Baby Model of Care, both in Philippines and the entire world.
Rising, S. and Jolivet, R. (2009). The Centering Pregnancy Group Prenatal Care Model. In Davis-Floyd, R., Barclay, L., Davis, B., & Tritten, J. (Ed.), Birth Models that Work (pp.365-384 ). Carlifornia: University of California Press.
The prenatal period encompasses a major life event for women and their families. It heralds the birth of a new family constellation, which brings with it awesome responsibility of parenting. Sharon and Rima take on the initiative of establishing the CenteringPregancy prenatal model of care. This multifaceted model integrates the three major components of prenatal care that is health assessment, education and support into a unified program within a group setting. It also provides a mechanism for continuity of health care into the wider scope of “continuity of caring” for women and families who form strong bonds during their group experiences together. Therefore, portraying this practice as a woman-centered and community based one. Sharon sees this model as a unique, refreshing approach and a powerful tool towards mother’s care. Consequently, this model also empowers mothers to choose health-promoting behaviours resulting to a positive health outcome including increased gestational age for mothers who deliver preterm. Through its use of groups, that provide a dynamic atmosphere of learning and sharing, it satisfies the delivery of prenatal care. This can be attributed to the Spanish-speaking women who through its application, benefited mostly from the comprehensive education. Summarily, this relationship-centered midwifery based model increases satisfaction expressed by both the women and their providers, thereby supporting CenteringPregancy model as an effective practice in terms of delivery of prenatal care.