Like many of us, you have experienced a different health care system before coming to Canada. Now here you are. You just learned you are pregnant and need to find a caregiver to help you during your pregnancy and labour.
Here are a few tips to help you choose a caregiver that best meet your needs so you can have a positive experience during your pregnancy and the birth of your child.
How does the Canadian health system work?
First, it is important for you to learn about your rights and about what is available in the Canadian Health Care System. In this article, I will be focusing on Ontario residents, as the healthcare coverage varies by province in Canada. However, I hope most of the information here can help you choose a caregiver that best fits your needs anywhere in Canada.
If you live in Ontario, and need to find out more on how to obtain your health card and eligibility, please visit: http://www.health.gov.on.ca/en/public/programs/ohip/
For other provinces, please visit the link below:
In Ontario, the health care system offers you two great options of caregivers, which are totally covered by your OHIP (Ontario Health Insurance Plan) card, meaning you do not have to pay for these services. They are:
- Physicians Obstetrics / Gynecologist (OB/GYN)
In the Canadian health care system, you need a referral from your family doctor to see an OB/GYN. This referral is not needed if you are choosing a midwife as your caregiver. However, since midwives are in high demand, I suggest you contact more than one midwifery clinic directly early on in your pregnancy, so you can increase your chances of finding one.
How to choose between these two types of professionals that will best fit my needs?
When choosing your caregiver it is important not only to consider their educational background, credentials, knowledge and experience, but also consider your state of health and what resonates with you or your belief system. Please see a brief introduction of these two models of care:
Midwifery Care Model
This type of care is intended to enhance and maintain a woman’s physiological and psychological resources for giving birth. The midwifery model is based on the following principles:
- Birth is a natural physiological process and an experience that can bring great emotional transformations.
- A woman’s feelings influences the labour process, so there is need for individualized care
- Childbirth preparation is necessary, as a woman’s active participation increases the chances of a healthy pregnancy, labour and birth.
- Lower rates of interventions and Cesareans are desirable
- Caregivers not only check the mother’s and baby’s safety and well-being, but also offer education and support. If problem occurs, they start with tools that cause the least intervention to regain a healthy physiological function. They are also highly trained to address emergencies as they arise.
- Midwifes provide care wherever you choose to have your baby. It can be at your home, at a birthing centre or at the hospital.
- They also provide pain management ranging from natural to pharmaceutical options including access to epidurals in hospitals.
Registered midwives are health professionals who provide primary care to women and their babies during pregnancy, labour, birth and the postpartum period. They’re trained for at least 4 years in Bachelor of Health Sciences (Midwifery).
Midwives’ services include physical examinations, screening and diagnostic tests, the assessment of risk and abnormal conditions, and the conduct of normal vaginal deliveries. Midwives work in collaboration with other health professionals and consult with or refer to medical specialists as appropriate. The midwifery model of care promotes normal birth, enables women to make informed choices, and provides continuity of care and support throughout the childbearing experience.
For more information on Midwifes please visit:
To find out if midwives are covered by the provincial health care across Canada please visit:
Medical Care Model (Physicians Obstetrics / Gynecologist)
This model is designed to replace or alter the body’s own resources with medical and technological interventions. It is based on the following premises:
- The natural childbirth is perceived as unreliable, unpredictable and potentially unsafe.
- Uses a routine care protocols for all women (not considering individual needs), which gives the caregivers a sense of control over the birthing process
- Medical interventions can improve labour and birth
- Cesareans are believed to be as safe as vaginal birth for mother and baby. Some believe cesareans are a safer option to vaginal birth
- Caregivers use routine interventions before problems occur. If a problem arises, doctors intervene rapidly with tools that will deliver the quickest result.
These professionals are medical school graduates with additional training in obstetrics (a medical and surgical sub-specialty focused on pregnancy, birth and the postpartum period) and gynecology (medical and surgical treatment of diseases). Much of their education is focused on detection and treatment of complications and disease as well as pharmaceutical agents, so they are well skilled in procedures and surgical interventions. Depending on your state of health, perhaps you have factors that contribute to a high-risk pregnancy that requires the skill-set of an OB/GYN.
The majority of OB/GYN’s are focused on high-risk cases and procedures and as a consequence are likely not to focus on the psychological needs of a pregnant / labouring woman.
For more information on OB/GYN physicians go to:
Can I change caregivers, if I am dissatisfied with the service provided?
You absolutely can.
It is important to find a caregiver who is concerned for your well-being, whom you feel comfortable with, feel listened to and trust his/hers recommendations, so that you can have a satisfying birth experience. However, do not drop your current caregiver until you have found a more suitable match to your needs that will be able to take you in as a patient.
Before rushing into making a decision to end the relationship with your caregiver, try to improve the communication with him/her, by conveying, in a kind and respectful way, the things that are making you uncomfortable. For example:
You may feel this way: “Dr. Smith, you seem always in a rush and you don’t let me ask you questions. You don’t care about your patients”. However, if you communicate directly in this way, it may sound accusatory and that can make your caregiver defensive and break any chances of good communication.
Here is how you can convey your feelings in a kind and respectful way using “I” statements: “Dr. Smith, sometimes it is hard for me to say, but I am under the impression I am an inconvenience to you. When I need more information, I feel that you are quick to dismiss my question and that I shouldn’t ask you anything.”
If this does not improve the relationship with your caregiver, definitely look for another one.
What is the difference between Midwives and Doulas?
A birth doula is a trained labour support person who provides informational, emotional and physical support to a woman in labour and her partner. As a doula, she can offer a wide range of comfort measures, but she will not perform any clinical tasks (clinical exams, risk assessment, screening tests, etc.) as the midwife or doctor would.
Doula services are privately funded, denoting that her services are not covered by the provincial healthcare system as of yet.
Article written by : Simone Costa, ND grad., Doula, BodyTalk Practitioner
- Penny Simkin, et al, Pregnancy Childbirth and The Newborn: The Complete Guide, 4th Edition, ISBN 978-0-88166-531-4 (Meadowbrook)