Fall 2010 - Association of Ontario Midwives

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 successSt. Joseph’s Healthcare Hamiltonhas recently had its Baby-friendlyHospital status re-designated thanksto interprofessoinal collaborationand education. This project has led toincreased communication and educationbetween physicians, nurses, midwivesand lactation consultants.Despite having first become aBaby-friendly Hospital in 2003, gettingre-designated was not a walk in thepark, according toShirin Aghili, RM, headmidwife at St. Joseph’s. “Being partBecause manyof the wholemothers coming intointerprofessionalSt. Joseph’s are fromcommunities thatmeeting processroutinely unnecessarily and being the headsupplement withmidwife is hugelyformula at birth untileye-opening,”the breast milk comesin, it was quite easy for - Shirin Aghili, RM,rates of breastfeedingHead Midwifeinitiation to slip belowdesirable levels.In addition, St. Joseph’snursery is in some ways working againstit. Though categorized as a level onenursery, Aghili says it is capable and oftendoes handle more complicated cases andinfants with more serious issues who mayrequire supplementation in the initialdays due to medical issues.“There was a need for regroupingand re-teaching the hospital staff,”Aghili said with regard to getting thedesignation back. For example, properdocumentation for babies coming intothe nursery is essential to show caseswhere supplementation is needed, suchas hyperbilirubinemia.“The hospital has implemented newforms that say the baby must be on thebreast for 14 minutes while in the deliveryroom,” Aghili said. “Skin to skin is highlyencouraged.”Patients also needed someeducation. For example, ifpatients indicate they planto formula-feed when theyregister at the hospital, theyare told not to be disappointedif staff ask again or promotebreastfeeding.In addition to encouragingthose who would normallysupplement at birth until themilk comes in to breastfeedearlier on and be patient withthe process, Aghili said theyalso recommend patients takeadvantage of on-call help as needed.Aghili said the process was spearheadedby a very dedicated Dr. Tamar Packer,Medical Director of Newborn Services atSt. Joseph’s, but also successful thanks toa great interprofessional environment.“The hospital is so proud they havemidwives (because they) know about ourgood breastfeeding rates,” she said.As head midwife, Aghili sits onmultidisciplinary steering committeesfor maternal, child and newborn health.Another midwife at her Hamilton practicesits on the regional lactation committee.The meetings provide a great avenuefor discussion and troubleshootingamong professional colleagues who havedifferent backgrounds and skill sets.“Being part of the whole meeting processand being the head midwife is hugelyeye-opening,” she said. “It allows us, asmidwives, to see what an institutionhas to face in order to increase thebreastfeeding rates. It is so easy tojust say ‘everybody breastfeed’ but toactually put it into practice and put it intoeducation is challenging.”Another positive outcome from theprocess was that the hospital’s lactationconsultant approached Aghili and askedif the practice would like additionalbreastfeeding education for its studentsand new registrants. Because theHamilton Midwives takes on manystudents, Aghili said they now routinelysend students to the breastfeeding clinic– which is available to clients throughself-referral seven days a week – foradditional breastfeeding education.The hospital’s Baby-friendly designation isreassessed every five years.www.aom.on.ca05

Interprofessional CareNew resource manual and conference launched to support hospital integration for midwivesA partnership between the Ontario HospitalAssociation (OHA), the Association ofOntario Midwives and the College ofMidwives of Ontario (CMO) is helpingmidwives, doctors and nurses work togetherto deliver better client care.A full-day conference onTuesday September 28,2010 and a reference “The OHA supportsguide - Resourceintegrating midwivesManual for Sustaininginto Ontario’s hospitals,Quality MidwiferyServices in Hospitals -and believes thathave been developed midwives are anto assist midwives,important part of thedoctors and nursesmaternity care system.”in interprofessionalcollaborative- Tom Closson,relationships.OHA President and CEODesigned for bothhospital leaders lookingto integrate midwivesfor the first time, as well as those whoalready have midwifery at their institution,the manual provides examples of existingintegration models and lessons learned.“Mothers and their newborns will definitelybenefit from having more, and better,interprofessional collaboration among theircaregivers. That’s why the OHA supportsintegrating midwives into Ontario’shospitals, and believes that midwives arean important part of the maternity caresystem, alongside their physician and nursecolleagues. This manual can help maternitycare teams improve and sustain positiveworking relationships, which will promotesafer, high-quality care,” said Tom Closson,President and CEO, OHA.On September 28, the conference, titledMaternal and Newborn Care: MeetingCommunity Needs and IntegratingMidwives, not only highlighted hospitalsleading in maternity care integration, butalso offered tips to maximize providercompetencies and information on liabilityissues associated with integration.Speakers included Ministry of Health andLong-Term Care lead on maternal andnewborn care Dr. Charlotte Moore, Collegeof Midwives of Ontario President AndreaLennox, RM, and Association of OntarioMidwives President Katrina Kilroy, RM.“Whenever I givea presentation oninterprofessional collaboration,be it at hospital rounds or atinterprofessional events likethis, it is always well received.Learning about one another’sroles and responsibilitiescreates better understandingamongst disciplines and opensthe door to improving the waywe all provide care to womenand newborns,” said Kilroy.Another well-received speakerwas Dr. Douglas Bell of theCanadian Medical ProtectiveAssociation (CMPA), the insurance groupthat covers physicians. Though physiciansmay claim they fear liability issueswith midwifery integration, that fear isunwarranted, Dr. Bell says.“In terms of whether there are lawsuitswhere doctors are brought in, it’s rare,”he says. “If a hospital is interested inintegrating midwives into their program,the hospital should have the doctors sitdown and discuss what the issues areand address those concerns. Physiciansshouldn’t be supervising midwives.”The OHA has sent the 63-page resourcemanual binder to every hospital in Ontario.Because it is brand new and thereforetopical, many head midwives are reviewingthe document with their maternity carecolleagues at unit meetings, MAC, andother hospital committees this fall.The resource manual is available for freedownload from the OHA website at:www.oha.com/KnowledgeCentre/Library/Pages/Manuals.aspxAOM toolkit aims athospital integrationIn additionto the newresourcemanualpublished bythe OntarioHospitalAssociation,the AOM hasdevelopeda variety ofresources to Hospital Integration CommitteeChair and AOM boardhelp members member Jane Somerville, RMadvance theirintegrationinto communities and hospitals.They include tip sheets, handouts,position statements andpresentations.These have all been gatheredtogether in one handy “HospitalIntegration Toolkit” for members.Central to this toolkit is an annotatedlist of all the resources. Additionallinks, materials and support areprovided to further facilitate theincrease of hospital integrationand growth of collaborativerelationships.Developed in consultation withthe AOM Hospital IntegrationCommittee, this toolkit is especiallyuseful for midwives seekingguidelines, policies and othermaterials that address existingbarriers to collaborative maternaland newborn care and to establishstrong relationships betweenthemselves and other health careprofessionals at hospitals and in thewider community.The toolkit was distributed atAOM fall regional meetings and isavailable on the AOM website.TORONTO: Maternal and Newborn Care: Meeting Community Needs and Integrating Midwives - OHA Conference September 28, 2010TOP LEFT: AOM members Andrea Lennox, RM, President of the College of Midwives of Ontario; Elizabeth Brandeis, RM, AOM Board Member; Sharon Swift, RMTOP RIGHT: Dr. Tony Pattinson, Chief OB/GYN Windsor Regional Hospital; Katrina Kilroy, RM, AOM PresidentMIDDLE LEFT: Tory Tudor, RM; Janet Skupsky, RN, Halton Healthcare Services; Allan Halls, CEO Halton Healthcare ServicesMIDDLE RIGHT: Conference delegates - over 100 people attended the conferenceLOWER LEFT: Dr. Charlotte Moore, Provincial Lead for Maternal, Child and Youth Health Strategy, Ministry of Health and Long-Term CareLOWER MIDDLE: Dr. Douglas Bell, Associate Executive Director and Managing Director, Risk Management Services, Canadian Medical Protective Association (CMPA)LOWER RIGHT: Clinical Nurse Educators Sharon Adams, RN, William Osler Health System; Bridget Mitchell, RN, William Osler Health Systemwww.aom.on.ca07

Consumer ResourcesNew breastfeedingbook, postersThe Womanly Art of Breastfeedingis a staple in manymidwifery clinics’ client lendinglibraries.First published over 50 yearsago as a booklet, the publicationhas grown with La LecheLeague International to be oneof the world’s leading authoritieson breastfeeding.A brand-new edition is nowavailable. Written by Canadianauthor and breastfeedingexpert Teresa Pitman, the 2010version includes technical informationalong with mothers’stories and handy tear-sheets.Ontario government introduces expanded online newbornregistration serviceWith just a few clicks, Ontario parentscan now apply online for child benefitprograms, including the Ontario ChildBenefit, when they register theirnewborns.In partnership with the Canada RevenueAgency and Service Canada, theServiceOntario website has expandedits Newborn Registration Serviceapplication. This online service nowprovides a quick, easy and secure way forparents to register their newborn, applyfor a birth certificate, a Social InsuranceNumber Card and Canada Child Benefits.This expanded service lets parentscombine four separate applications intoone easy-to-use online process from thecomfort of their home. No waiting inline and faster processing times makesit easier for busy new parents to crossanother thing off their to-do list.Ligue La Leche, the Quebecdivision, has a new series ofbreastfeeding posters for salein English and French.Order here: www.allaitement.ca/produits/affiches.phpCanadian PaediatricSociety calls for milk banksPasteurized human milk is arecommended alternative forhospitalized sick newborns when theirown mother’s milk is not available,according to a new statement by theCanadian Paediatric Society. Thestatement, published in the Novemberissue of Paediatrics & Child Health,says that human milk banking inCanada should be encouraged andpromoted.“The most vulnerable babies shouldreceive human milk,” said Dr.Sharon Unger, principal author ofthe statement and member of theCPS Nutrition and GastroenterologyCommittee. “Only about half of themothers of these babies will have anadequate milk supply, sometimesbecause they are sick themselves, ordue to the stress of having a very sickbaby or from being separated fromtheir baby.”Yet the supply of donor breastmilk in Canada is limited. The onlyhuman milk bank in Canada, based inVancouver, can’t meet the needs of allbabies who could benefit.The statement recommends strictcontrols on how and when humandonor milk should be used. It alsorecommends continued research intothe benefits of banked human breastmilk for preterm infants in the NICU.To access the full statement, visit:www.cps.ca8 ontario midwife • Fall 2010

Research / Government InitiativesEileen Hutton, RM, PhD, recently accepted a five-year, endowed professorship at Vrije University in Amsterdam in theMidwifery Science Division, the first midwife to ever carry the title “Professor” in the Netherlands.Midwife-researcher appointed to Dutch professorshipThough Ontario has borrowed much fromthe Dutch model of midwifery care, it isnow our turn to give back.This past summer, Eileen Hutton, RM,PhD accepted a five-year, endowedprofessorship at Vrije University inAmsterdam in the Midwifery ScienceDivision. Hutton is the first midwife toever hold a professorship role in theNetherlands, as most midwifery educatorsthere hold a lecturer title.“I think someone from Canada iswell-suited to move into that positionsince our model is so highly influencedby their model,” Hutton said. “It is veryfitting that we borrowed from them andare now contributing to their programs.”She will continue with her role asassistant dean of the Midwifery ofEducation Program at McMasterUniversity, where her researchbackground is already a valuable asset.In addition to her bachelor in nursing,master’s in parent child nursing andmidwifery degree, Hutton holds a PhD inclinical epidemiology – the study of healthpatterns amongst populations.Her research work has garnered herseveral awards, including the MichaelSmith Foundation for Health ResearchCareer Scholar award, the CanadianInstitutes of Health Research NewInvestigator Award as well as the Societyof Obstetricians and Gynaecologists ofCanada Western Regional Award.Hutton has been a coauthor in at least 10academic research papers investigatingtopics such as home birth, sterile waterinjections to treat pain, external cephalicversion, breech birth and late versus earlycord clamping. Her research focuses onclinical trial methodology and knowledgetranslation.For the Dutch professorship, Hutton willbe mainly working with other professorsand academics from a research point ofview, rather than in a traditional teachingposition. She sees the role as beingtransitional and hopes that after her termis up, there will be Dutch midwives whowill be able to move into the position.She currently plans to travel to theNetherlands several times a year.Hutton’s new role as the Vrije head of themidwifery sciences department evolvedover time. Three years ago she visitedthe university to learn more about theirresearch and research units.Following this came the idea that Huttoncould take on the duties of a visitingprofessor, which eventually developedinto the current professorship role. Huttonthinks it is a good fit for both Canadaand the Netherlands. While the Dutchinstitute will make use of her expertise todevelop its research capacity, Hutton andother researchers will benefit from thecountry’s longer history of midwifery careMidwives support NursePractitioner scope reviewThis summer, the provincialgovernment announcedconsiderations to expand the roleof nurse practitioners by allowingthem to admit, discharge andtransfer patients in-hospital andannounced a public consultationlooking into how patients wouldbenefit from these changes.The AOM took the opportunityto submit a letter of support,highlighting lessons learned fromthe integration of midwives intohospitals.When midwives gained hospitalprivileges with regulation, ittranslated into benefits for bothhospitals and patients – midwiferyclients are known to havesignificantly shorter hospital staysand lower rates of readmission.Nurse practitioners with a greaterrange of responsibility in hospitalscould result in similar benefits.The government is now reviewingfeedback it received in theconsultation process and plans tomeet with individual stakeholdersthroughout the fall.When Bill 179 was passed lastDecember, nurse practitioners’ roleswere expanded to allow them tocommunicate diagnoses to patients,to perform procedures below thedermis and to order X-rays withoutrestrictions, among other things.The new push from governmentto expand the role of nursepractitioners is part of the FamilyHealth Care for All Strategy – whichaims to address patients who donot have a primary care provider– and comes in advance of theexpected opening of 25 nursepractitioner-led clinics in Ontario in2012.and rich study population.“Access to a country where midwifery isthe norm and where large numbers ofwomen receive midwifery care – alongwith building collegial relationships – willhave benefit to us as well,” Hutton said.www.aom.on.ca09

National NewsEDMONTON: A few Ontario delegates to the Canadian Association of Midwives conference gather at the end of the conference.Back row: Katrina Kilroy, RM (AOM President); Kathi Wilson, RM; Nicole Bennett, RM; Karline Wilson, RM; Nadya Burton, MEP Assistant Professor; Anne Wilson, RM (CAM President-Elect);Lisa Weston, RM (AOM Vice-President); Chris Sternberg, RM; Deborah Bonser, RMFront row: Juana Berinstein (AOM Director of Policy and Communications), Esther Willms, RM (AOM Board Member); Mary Sharpe, RM (MEP Director-Ryerson)nationalThe Canadian Association of Midwives hosted its 10thAnnual General Meeting this October in Edmonton, AB,with a focus on place of birth. The conference hosted manynotable speakers, including AOM President Katrina Kilroy,who gave a presentation to other midwives about how toeducate physician and nursing colleagues at hospital roundsabout home birth. In addition, it was announced that Ontariomidwife Anne Wilson will take over as CAM president inJanuary 2011.ontarioOntario midwives now number over 500: new graduatesstarted providing care this summer. This August, Ontario’snewest group of midwives were registered, pushing the totalnumber of practitioners to an all-time high of more than 500.Jackie Klan, RM, is one of the new registrants. “My journeyof receiving care from a midwife for my own daughter’sbirth seven years ago was so profound it made me realize itwas something I wanted to offer back to people,” Klan said.Association of Ontario Midwives President Katrina Kilroy,RM, was one of the sixty midwives to be registered when theprofession was regulated in 1994. “It was a privilege to be inthat first group of midwives registered in Ontario,” Kilroy said.“I’m delighted that we’ve hit this mark and even more familiescan access the high quality of care midwives provide.”New BrunswickThis August, the New Brunswick Midwifery Act wasproclaimed - the final process of integrating midwifery inthe province whereby the provincial government formallyrecognizes midwives as health care professionals andapproves the regulations set out by the Midwifery Council ofNew Brunswick. The Midwifery Council has been meeting todevelop standards of practice, policies and to determine scopeof practice.saskatchewanHealth Minister Don McMorris led the launch of theCypress Health Region’s Midwifery Program on October 18,recognizing Swift Current’s first midwife, Maud Addai, aswell as the nurses, physicians and other staff involved in thedevelopment of the innovative and historic program at theCypress Regional Hospital. The midwifery program brings anadded dimension to the birthing services currently offered bythe Cypress Health Region, which is only the second healthregion in Saskatchewan to offer the service. Maud Addai isone of just eight midwives in the province, seven of whomare actively practising, and she brings almost 20 years ofexperience gained in the United Kingdom to her role in SwiftCurrent.10 ontario midwife • Fall 2010

AOM ESW WorkshopsAll courses listed are regular EmergencySkills recertification workshops. Instructortraining will be offered in conjunctionwith the AOM annual conference.To register for ESW courses, visit the AOMwebsite at www.aom.on.ca/Professional/Emergency_Skills_Workshop/or contact events@aom.on.ca, 416-425-9974 x2255.• Mississauga/Oakville- December 10, 2010Plan now for 2011:• Toronto - February 18, 2011• Ottawa - March 25, 2011• Windsor - April 15, 2011• TBA Conference location May 2011• Sudbury - August 19, 2011• Kingston - September 16, 2011• Barrie - September 23, 2011• London - November 18, 2011• Toronto - December 16, 2011The AOM is proud to announce that theESW for Paramedics has been a successand will become a regular offeringthrough the Sunnybrook-Osler Centrefor Prehospital Care’s ContinuingMedical Education Program. Membersoutside the Toronto area who wouldlike to see this program offered in theircommunity should contact ChristineStaley, CPD Director at cpddirector@aom.on.ca or 416-425-9974 x2224.Conferences of Interest - more at www.aom.on.ca “Professional Development”Pregnancy and Birth Current Clinical Issues: SunnybrookDecember 9-10, 2010 in Toronto, ONcmicr@sunnybrook.ca7th Annual Obstetrical Malpractice: A Survival Guide for 2011Mount Sinai Hospital/University of Toronto Dept. of Ob/GynJanuary 15, 2011 in Toronto, ONwww.mountsinai.on.ca/education/staff-professionals/cmePromoting Health Equity: Action on the Social Determinants ofHealthRyerson University, Faculty of Community ServicesFebruary 11-12, 2011 in Toronto, ONwww.ryerson.ca/fcs/conference/Best Start Resource Centre 2011 Annual ConferenceBest Start Resource CentreFebruary 22-24, 2011 in Toronto, ONwww.beststart.org/events/detail/bsannualconf11/HIROC AGMHealthcare Insurance Reciprocal of CanadaMay 2, 2011 in Toronto, ONwww.hiroc.comConsensus Conference: What is the future of Birth and whydoes it Matter?Morris J. Wosk Centre for Dialogue - UBC Collaboration forMaternal and Newborn Health, BC Women’s Hospitals CesareanTask Force & The Power to Push CampaignMay 11-13, 2011 in Vancouver, BCwww.cmnh.ca9th Annual Refresher in Primary CareMount Sinai Hospital/University of Toronto Dept. of Ob/GynMay 13, 2011 in Toronto, ONwww.mountsinai.on.ca/education/staff-professionals/cmeICM 29th Triennial CongressJune 19-23, 2011 in Durban, South AfricaCall for Abstracts deadline: September 1, 2010www.midwives2011.orgMedical Disorders in PregnancyMount Sinai Hospital/University of Toronto Dept. of Ob/GynNovember 26, 2011Mount Sinai Hospital, Toronto, ONwww.mountsinai.on.ca/education/staff-professionals/cmeCanadian Conference on Medical Education (CCME)Association of Faculties of Medicine of CanadaMay 7-11, 2011 in Toronto, ONwww.mededconference.caOntario Midwife is a quarterly publication of the Association of Ontario Midwives. This publicationis available online at www.aom.on.ca, or you may request a printed copy. All websites listed are“hotlinked” in the digital copy. Scroll over the website address and click to launch the site.We welcome all feedback. Please contact Joanna Zuk, Senior Communications Officer:comms@aom.on.ca, or by phone: 416-425-9974 x2261 or 866-418-3773 x2261.Association of Ontario Midwives, 365 Bloor St. E., Suite 301, Toronto, ON M4W 3L4Association of Ontario Midwives©2010 Association of Ontario Midwives, all rights reserved.

AOM Clinical and ProfessionalDevelopment Program 2010/2011Working with Special Client PopulationsLondon, December 3, 2010This day is designed to assist careproviders in providing prenatal, labourand postpartum care to women and theirfamilies affected by and coping withaddictions, mental health and settlementissues.Providing Perinatal Care for Lesbian,Bisexual, and Queer (LBQ) Women andtheir FamiliesToronto, January 21, 2011 (morning)Providing Perinatal Care for Trans Clientsand their FamiliesToronto, January 21, 2011 (afternoon)These two sessions will take amultidisciplinary approach to thepromotion of clinically appropriate andculturally competent perinatal care for LBQwomen and trans-masculine clients whoare pregnant.Near Misses and Poor Outcomes inMaternal/Newborn Care: Issues FacingCare ProvidersHamilton, February 25, 2011This day will explore the practical andpsycho-social issues facing care providerswhen supporting clients and each otherfollowing a near miss or poor outcome.Webinar Lecture SeriesJanuary 12; January 26; February 9;February 23These webinars are designed to createan atmosphere of workplace learning,communication and collaboration.Sessions aim to inform participants of newdevelopments, legislation, topical issues,and best practices. The webinars aredesigned to cover a topic in approximately60 minutes and can be accessed from thecomfort of your own home or office. Theywill also be recorded and posted on ourwebsite for midwives unable to attend.E-learningThe AOM currently offers a self-pacede-learning course on informed choice toall members. An additional course willbe introduced during the 2010/2011educational year.Discussion ForumsDiscussion Board Forums are beingdeveloped where members cancommunicate, collaborate and discuss avariety of clinical and leadership issues in acollegial online environment.Leadership ProgramThe AOM recently held several wellreceivedLeadership and Media SkillsWorkshops in Burlington, Barrie and viawebinar.The Media Skills webinars will be madeavailable on the AOM website for allmembers who were unable to attend.Professional Development FundThe Professional Development Fund isavailable to members again this year andapplications are currently being acceptedfor this program.www.aom.on.ca/Members/Professional_Development_FundRegistration:Registration for all events is availableon the AOM website. Register online ordownload a form to print and fax or mailwith payment.To comment on or contribute to the AOMClinical and Professional Developmentprogram, contact cpddirector@aom.on.ca