In general, women will choose ONE type of care provider for their pregnancy. However, in select cases, shared-care may be arranged with different provider types.
Choosing a care provider can be confusing. The following is a brief outline of the different provider types and models of care offered at BC Women’s Hospital.
Midwives provide comprehensive care for women during normal, low-risk pregnancies. They also look after the mother and newborn for the first 6 weeks post-partum. Women can self-refer.
Midwives offer choice of home or hospital birth, and some offer water birth.
In BC, the practice of midwifery is regulated by the College of Midwives of British Columbia. Midwives are members of the inter-professional team at BC Women’s Hospital and work closely with family physicians, OBs, and maternity and public health nurses.
Midwives usually work in small groups. Prenatal visits tend to be lengthier. Midwives provide home visits in early labour (for women planning hospital birth) and postpartum. They manage normal deliveries, and will consult an OB for problems that arise during pregnancy or in labour, and if an assisted vaginal delivery or C-section is required.
Some family physicians provide maternity services for patients of their practice. This can include prenatal care only, or prenatal care and delivery. In recent times, the number of family physicians providing full maternity care to their regular patients has decreased significantly.
Most family physicians providing maternity care now do so in groups that care for women and their newborns for the duration of the pregnancy and the first 6 weeks post-partum. After this time, women return to their regular family physician. Women can self-refer to these groups.
Family physicians do not generally offer home birth.
Group arrangements differ greatly. Some women see a single physician in their office for their prenatal care, but may be cared for by the group doctor-on-call in labour. In other groups, prenatal visits rotate among the various providers.
Family doctors are able to manage routine medical problems that arise during pregnancy. They attend normal deliveries, and may perform vacuum deliveries in some cases. They will consult an OB for certain pregnancy complications, or when women require a forceps delivery or C-section.
OBs have completed 5 years of specialized training in obstetrics and gynecology. All of the OBs at BCWH are fellows of the Royal College of Physicians and Surgeons, and carry the FRCSC designation.
To see an OB for maternity care, women must obtain a referral from their primary care provider. Care for the mother continues until 6 weeks post-partum. However, OBs do not look after the newborn. In hospital, the newborn is cared for by the pediatrian on-call. After discharge, the baby’s care is assumed by the family physician.
OBs have the knowledge and skills to manage both normal and high-risk pregnancies, including all types of delivery (normal, vaginal breech, vacuum-assisted, forceps, and C-section). OBs also perform specialized procedures, such as cerclage (cervical stitch) and external cephalic versions (turning breech babies).
Home birth and water birth are not offered.
Prenatal care takes place in the private office of the primary OB, and labour and delivery is managed by the OB on-call. Planned C-sections are done by the primary OB.
MFMs are OBs who have completed a two-year fellowship in very high-risk obstetrics. They do not generally provide primary care, except in very complicated pregnancies.
They mainly provide consultative services to other providers from the entire province of British Columbia for pregnant women who have complex medical problems, or whose fetuses are found to have abnormalities.
They are the physicians who interpret ultrasounds at BC Women’s Hospital and also perform in-utero procedures (eg. amniocentesis).