Fall 2010 - Association of Ontario Midwives

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Interprofessional Care Family Health Team welcomes midwife As the first midwife in Ontario to formally have clinic space within a Family Health Team (FHT), Andrea Cassidy is able to informally consult with physicians, nurses and social workers whenever she needs. Although the arrangement is still in the early stages – Cassidy has only had space within the Family Health Team for a couple of months – she says it has been an extremely positive experience. “Being a new midwife coming into this community, this arrangement has made the relationships really good,” she says. And it’s obviously a popular set up that works for the other providers as well – this is the second Family Health Team to approach Cassidy. Though the first team was too remote, Cassidy has found a great fit with the Leamington and Area Family Health Team. Although she is not an employee of the FHT, the arrangement provides Cassidy’s clients enhanced care because she has lots of support and resources at her fingertips. If a client is having trouble with her partner or at home, Cassidy refers her to the social worker. If a baby is struggling with jaundice a little longer than they should, she consults with one of the physicians right in the clinic. “The other thing I find beneficial is seamless care – clients go from their family doctor or nurse practitioner to me, then back again. If there’s something going on with their care we can work together,” she says. She’s not the only one who benefits from knowledge sharing – new nurses or nurse practitioners who are hired into the FHT shadow Cassidy to learn about midwifery and she currently has a fourth-year nursing student completing a placement with her. “Ultimately, physicians, nurses, midwives – we all want to provide excellent care,” she says. Nadia Bellio, RM, and Natalie Tregaskiss, former L&D nurse and current student midwife, hold newborn Isabella Liut. Shorter midwifery education program ideal for nurses Deciding to go back to school once you’ve already completed an undergraduate degree in order to move your career in a new direction is a daunting decision, especially when you think about having to put in another four years. But that doesn’t always have to be the case. For those with a health professional degree, such as nursing or medicine, the Midwifery Education Program (MEP) offers the Post-Baccalaureate Program for Health Professionals, allowing those who already have a background in health care to complete their midwifery degree in only two years. Dr. Susan James, Director, MEP of Laurentian University said when the MEP was expanded in 2007, the Ministry of Health and Long-Term Care asked if it would make sense to add a stream for nurses. James had already helped one student receive a combined nursing and midwifery degree in a five-year program and knew she could make it work. “If we could get a student to finish a nursing and midwifery degree together in five years, then surely someone who has graduated and has maternity care experience could complete a midwifery degree in two intense years,” James said. Nurses are a logical fit because so many of the courses they take in nursing school overlap with courses midwifery students take: anatomy, physiology, biology, chemistry and a social/cultural course – but anyone with a degree in health care, including physicians and pharmacists, is eligible. Laurentian has set up its program so that it works as a transfer credit system: any credits already earned are transferred to count toward the midwifery degree. There are currently two students enrolled at Laurentian who will graduate in two years – the spring of 2012. Ryerson also currently has two students enrolled – a new student who started this fall like her colleagues at Laurentian, and one who started the program last year and will be graduating from the post-baccalaureate program this coming spring: Natalie Tregaskiss. Though interested in pursuing a career in midwifery, Tregaskiss had already completed two bachelor degrees and had worked as a labour and delivery nurse in Toronto for five years. At this stage of her career, “the thought of another four-year degree seemed unfeasible,” she said. But having worked with a midwife at St. Michael’s Hospital, Tregaskiss learned of the condensed program and thought it was a great fit. “I am delighted to finally be doing what I have always wanted to do – it feels right,” she said. The “intense” program means students work straight through six semesters without summer breaks. While the core midwifery courses and clinic hours are the same, Tregaskiss said it helps to get credit for previous schooling and experience. “I hope more health professionals become interested in the program and that the program makes midwifery education more accessible to those like myself who are already working in the field,” she said. To apply, visit www.ryerson.ca/midwife or www.midwifery.laurentian.ca 04 ontario midwife • Fall 2010
Midwives, nurses, physicians and hospital administrators cement positive interprofessional relationships when working on projects such as Baby-friendly certification. Interprofessional team leads to Baby-friendly success St. Joseph’s Healthcare Hamilton has recently had its Baby-friendly Hospital status re-designated thanks to interprofessoinal collaboration and education. This project has led to increased communication and education between physicians, nurses, midwives and lactation consultants. Despite having first become a Baby-friendly Hospital in 2003, getting re-designated was not a walk in the park, according to Shirin Aghili, RM, head midwife at St. Joseph’s. “Being part Because many of the whole mothers coming into interprofessional St. Joseph’s are from communities that meeting process routinely unnecessarily and being the head supplement with midwife is hugely formula at birth until eye-opening,” the breast milk comes in, it was quite easy for - Shirin Aghili, RM, rates of breastfeeding Head Midwife initiation to slip below desirable levels. In addition, St. Joseph’s nursery is in some ways working against it. Though categorized as a level one nursery, Aghili says it is capable and often does handle more complicated cases and infants with more serious issues who may require supplementation in the initial days due to medical issues. “There was a need for regrouping and re-teaching the hospital staff,” Aghili said with regard to getting the designation back. For example, proper documentation for babies coming into the nursery is essential to show cases where supplementation is needed, such as hyperbilirubinemia. “The hospital has implemented new forms that say the baby must be on the breast for 14 minutes while in the delivery room,” Aghili said. “Skin to skin is highly encouraged.” Patients also needed some education. For example, if patients indicate they plan to formula-feed when they register at the hospital, they are told not to be disappointed if staff ask again or promote breastfeeding. In addition to encouraging those who would normally supplement at birth until the milk comes in to breastfeed earlier on and be patient with the process, Aghili said they also recommend patients take advantage of on-call help as needed. Aghili said the process was spearheaded by a very dedicated Dr. Tamar Packer, Medical Director of Newborn Services at St. Joseph’s, but also successful thanks to a great interprofessional environment. “The hospital is so proud they have midwives (because they) know about our good breastfeeding rates,” she said. As head midwife, Aghili sits on multidisciplinary steering committees for maternal, child and newborn health. Another midwife at her Hamilton practice sits on the regional lactation committee. The meetings provide a great avenue for discussion and troubleshooting among professional colleagues who have different backgrounds and skill sets. “Being part of the whole meeting process and being the head midwife is hugely eye-opening,” she said. “It allows us, as midwives, to see what an institution has to face in order to increase the breastfeeding rates. It is so easy to just say ‘everybody breastfeed’ but to actually put it into practice and put it into education is challenging.” Another positive outcome from the process was that the hospital’s lactation consultant approached Aghili and asked if the practice would like additional breastfeeding education for its students and new registrants. Because the Hamilton Midwives takes on many students, Aghili said they now routinely send students to the breastfeeding clinic – which is available to clients through self-referral seven days a week – for additional breastfeeding education. The hospital’s Baby-friendly designation is reassessed every five years. www.aom.on.ca 05
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Fall 2010 - Association of Ontario Midwives

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