BC Medical Services Plan (MSP) covers midwifery services for all BC residents that have a personal health number.  There is a fee for a full course of care that includes labor and birth.   In Vera’s  current service offering,  MSP covers a phase of trimester care: 1st trimester (care ending around 13 weeks) 2nd trimester (care ending around 27 weeks) prenatal care and a phase of postpartum afterbirth care (from 1st week until to 6-7 weeks postpartum).

In BC healthy pregnant residents have the choice in areas where services are available of a general practice doctor, or a midwife that undertakes perinatal services for their prenatal, labor and birth care.

Often it is challenging to access a continuous service when a person first finds out they are pregnant 4-9 weeks of a pregnancy.  Pregnant people at the beginning of their journey have the choice to undertake their initial first and second trimester prenatal care with a family doctor, a walk-in-clinic physician or a midwife. When clients enrol into Vera’s initial prenatal care they are signing up for a phase of care.  Until they access ongoing prenatal, labor and birth care. 

The midwifery model of care allows for 30 – 60minute appointments and pays midwives for a phase of early care that usually includes 2 or more visits that are a mix of virtual and in person apporintments.  MSP does not allow double billing for the same service. 

Vera transfers her prenatal clients ~ 4 weeks after their last scheduled appointment with her that is usually between 10 – 13 weeks or 21-25 weeks pregnant to their ongoing prenatal, labor and birth midwife or doctor.  Her clients records are faxed to their next provider before their first ongoing care appointment.  This process avoids duplication of services and appointments and allows for a seamless transfer of care.

Vera has a consultation fee $65/half hour for a private consultation and prefers only to undertake private consultations with folk that do not have MSP.  Her fee for folk that have to pay privately is the equivalent to an MSP covered phase of care. 

If you live on the North Shore, have no family doctor and have had no prenatal care, or just one visit with a  family or walk-in-clinic doctor before realizing midwifery early pregnancy care is an option.  You are eligible for Vera’s initial early pregnancy service. Folk who have a family doctor would need to cancel any upcoming appointment they may have with their GP.   MSP does not allow midwifery and family practice services at the same time.  As this would be a duplication of services. 

When a person has seen a doctor once,  Vera would  give them a  release of records consent form to sign,  to request the result of any test that a doctor has ordered.

MSP also has a midwifery consultation and assessment fee that allows for collaboration between services. This fee gives family doctors and obstetricians  an ability to reach out and use the skills and services of a midwife to meet the mobility, lactation and/or complex primary perinatal care needs of the pregnant and postpartum people that utilize their services.

The fee also allows for midwives to reach out to their colleagues when they have a work-flow need.  Vera is pleased to assist her colleagues when possible. 

Between clients regularly scheduled visits, Vera has a contact messaging system that clients can access during 9am in the morning and 11pm at night, 7 days a week.

Vera’s clients have the ability to decide on the type of response, their need to speak directly with Vera, requires.  If they deem their call important and non-urgent, they write ‘Telephone call requested’, as well as their name and their telephone number into the message.  After sending the message, they ensure that their ringer is on.

Vera responds to regular non-urgent telephone requests within 4-6 hours, or sooner, from the time that she receives a request for a telephone cconsultation. 

A request for a regular call  enables her to respond at her convenience, in her lunch hour, or after a workshop or at the end of  her day.  This agreement enables her to balance her current work-life.

If a client deems their concern is time-sensitive they must indicate this in the message  ‘Urgent telephone call requested’, along with their name and telephone number.  Vera then priorizes this request and returns a time-sensitive request within an hour of receiving the message. 

This agreement provides her clients a degree of control over their early parenting life and over the support that they may need.   

Understanding and respect for each other’s circumstances forms a foundation for the partnership, which Vera aims to develop with all families in her care. 

Since she practices within the healthcare system and a community of care and because, she recognises that she is only one person connected to her clients via technology and is aware that both she and technology have a chance of breaking down.   All clients in care are intructed to do the following in the event of a rare, unexpected urgent concern:

Between 11pm and 9am, if a rare unexpected urgent health concern were to arise for their themselves, or their babies. They must to go to LGH emergency room.  Clients must also go to the ER if they have an urgent concern and have been unable to connect with Vera during her availability hours.  

If a client is uncertain that their concern warrants an ER visit, they are instructed to call 811, the 24 hour provincial healthcare nurse line.

In the rare instance that clients do go to the ER, Vera also requests that her clients email her that they have gone to the ER. So that she can follow up.  

Midwives and family doctors that undertake prenatal, labor and birth care, refer women with health issues outside of their scope of care to specialists.  Some family doctors have a scope of practice that crosses over with a specialist scope of practice and can manage more health issues under their own scope, compared to midwives scope of practice. . 

In some circumstances, an Obstetrician will share care with a midwife and this is covered by MSP.  In other circumstances, on-going specialist care with the Obstetrician as the most responsible provider is in the best interest of a person and their pregnancy.  Midwives completely transfer care in these circumstances.

There are health issues that many pregnant folk have had for a number of years before they fell pregnant, which other specialists manage, such as endocrinologists, gastroenterologists, psychiatrists, who see pregnant folk during and after their pregnancies for the related health issue their expertise covers. These specialists provide their services along side midwifery care. 

There are no barriers that prevent BC Midwives from referring and consulting with specialists.  On the North Shore, Vera has referral pathways to Reproductive Mental Health Specialists that can assist pregnant folk manage anxiety or depression medication, as well as to Endocrinologists that can assist folk manage thyroid conditions.  There are also specialised assessment programs, like St Paul’s Cardiac Obstetrics Program that midwives can refer any client that has had a cardiac issue for assessment. 

In addition, when a client or their newborn has a health issue midwives have the ability to call and discuss the health concern with a specialist that is on-call: obstetritrian, pediatriation or radiologist and either report back to a client or arrange for a client to be seen by the specialist and/or have another test undertaken before they do.  Vera considers that her practice has excellent support from her medical specialist colleagues in the hospital and in the community. 

During a pregnancy should a medical issue arise that is not related to pregnancy and that is outside of a midwife’s scope of practice.  A client can see their family doctor to assist with this kind of medical concern.  Vera requests that her clientele inform her if a medical concern  arises during their pregnancies, so that they can decide together if the concern is related to pregnancy, for instance urinary tract or vaginal yeast infection that she can treat, or if  the concern is  unrelated to pregnancy arises and outside of her scope of practice, such as sprained wrist, brochitis, sinusitus.   Folk that do not have a family doctor, who have a medical concern, midwives refer to walk-in-clinic doctors, nurse practitioners, or urgent care centers.   

So that a midwife can provide quality care, as well as plan for a work-life balance. Many midwives throughout the province have a capacity limit on the number of courses of care (or phases of care) that can be provided annually by their practice. Vera has maintained a quality of care and work-balance approach in her partial midwifery services too.

There will be months when her partial practice is closed, either due to reaching her capacity, or because she is having time away from clinical work for professional or personal reasons. In this situation Vera informs interested clients that have self-referred and/or  doctors  and the clients thatthey  have referred that her capacity is full and does her best to refer these folk onto her midwifery colleagues when possible, who are offering similiar services on the North Shore or in Vancouver.

Midwives are primary caregivers of well pregnant folk during their whole pregnancy, labor, birth and postpartum. We are also primary caregivers of well newborns until 6-8 weeks postpartum and have expertise to assist parents with breastfeeding.  Midwives can also access their physician colleagues for a consultation discussion that they can refer back to their clients.  Consequently, pregnant or postpartum folk do not see a doctor at the same time that they see a midwife for maternity care. As midwives are able to order and interpret all maternity tests and prescribe treatments for maternity related conditions during pregnancy, labor, birth and postpartum. Clients can access test results by applying for my e-health and can discuss results with a midwife during their visits. Should a need arise for a doctor, at any time during their care, a midwife will make an appropriate referral. It is important to inform your midwife of your health concerns. In the rare instance that a midwife is unable to provide services, it is our responsibility to arrange for another midwife, or doctor to provide a client’s care.

MSP only pays for one primary-care provider for healthy folk. Pregnant and postpartum folk have the choice to arrange care, with either a midwife, or a family doctor that provides pregnancy, postpartum and newborn care. Both midwives and family doctors, refer to specialists in the hospital and the community, should a health issue arise that is outside of their scope of practice to treat.

Midwifery postpartum services end 6-8 weeks after the birth of a baby.  At this time a client’s care is returned to their family doctor. If  a client does not have a family doctor, midwives can refer folk to a primary care nurse practitioner. 

It’s important to begin your care in the first trimester, when you first discover that you are pregnant. So that you can access a blood test to confirm your pregnancy home test results, ensure a viable uterine pregnancy,  an ultrasound to confirm location of pregnancy, number of fetuses and  accurately date your pregnancy.  Dating ultrasounds have been shown to reduce the chance of having unnecessary medical intervention at the end of pregnancy. Starting care early, also affords an opportunity to find out how life-style affects pregnancy and to undertake optional time-sensitive prenatal genetic screening that can tell a pregnant person about their chance of having a baby with  a genetic condition like Down syndrome and trisomy 18. The markers of this test, also screen placental function and a risk of preeclampsia.  Spina bifida (neural tube defect) can also be screened for  in early pregnancy depending on the type of genetic screening test chosen. Otherewise neural tube defect can be looked for in a detailed ultrasound at a later stage of pregnancy, when the growth and developement fetus’s spine and limbs are considered.

See an informed decision making tool that may help you make a decision to undertake, or forego optional early genetic pregnancy testing: Prenatal Genetic Screening: Decision Aid

Every time a person is pregnant there is an approximate 3/4 chance that a pregnancy will stay and grow well and 1/4 chance of miscarry.  Prenatal blood and ultrasound tests can confirm how a pregnancy is doing.  In the hard circumstances  that a pregnancy has stopped growing,  Vera’s clients  have someone to journey with them, who can also refer them to an appropriate specialist service if needed. 

At this time MCNS regular in-person office appointments are routinely scheduled only on Wednesday between 2pm – 8pm at Shipyards Health in Lower Lonsdale. Depending on Vera’s capacity, she will have between 2 – 4 Wednesday clinic days. 

Vera undertakes scheduled remote visits on Wednesday mornings.  Home visits, unscheduled telephone calls and email communication take place on Tuesday through Thursday, in between Vera’s other activities.  

When a pregnant person chooses to come into early pregnancy care, there are usually 2 -3  initial appointments relatively close together that are a mixture of remote and inperson visits.  So that questions can be addressed,  a history can be obtained, a physical examination be untaken, a fetal heart heard and requisitions provided for all routine and optional tests and results reviewed

Vera’s early  prenatal care is transferred to a midwife, or a doctor who undertakes ongoing prenatal,  labor and birth care, between 14 weeks and 28 weeks of pregnancy weeks after a client’s last scheduled visit with Vera, which is either between 10 – 13 weeks following a dating ultrasound, or between 21-25 weeks pregnant following detailed ultrasound.

Vera’s midwife colleagues on the North Shore with privileges at Lionsgate Hospital,  who work out of Canopy Midwives and Babease are pleased to accept her early pregnancy clients into their practices when they have capacity. 

Lionsgate Maternity Clinic that is a group of maternity family doctors will accept Vera’s early pregnancy clients that prefer family practice care, or who were not able to access ongoing midwifery care. 

When Vera’s clients access ongoing care with a midwife or doctor, it is important that they inform the midwife or doctor’s front desk that they are in Vera’s early pregnancy services and that they  arrange to have their 1st ongoing appointment  4 weeks after their last scheduled appointment with Vera.  They then inform Vera, who they have found for their ongoing care, and the date and time of their appointment with their next provider.  So that Vera can transfer their care, and fax their records to their ongoing prenatal, labor and birth provider’s office, ahead of their first visit. Respecting this process enables a seamless transfer of care with no, or little duplication of appointments or services. 

Vera’s  early pregnancy services are a mixture of remote and inperson visits that take place in  Shipyards  Health in North Vancouver City,  All postpartum families living in Vera’s visiting area have home visits scheduled during the first  few weeks afterbirth.  Their last 2 visits are scheduled in Shipyards Health.   Vera’s clientele are discharged from her midwifery care around 6 to 7 weeks postpartum.

During their care clients can request a telephone consultation, or additional visit, in between scheduled visits via her email paging system.

Midwifery appointments are arranged via email. Appointment reminders are sent via an electronic scheduling app in Vera’s electronic medical record.

Folk living within 10 km from Quayside Village and /or who are flexible with Vera’s limited office appointment schedule get priority in Vera’s Intake process.

There will be months when her partial practice is closed, either due to reaching her capacity, or because she is having time away from clinical work for professional or personal reasons. In this situation Vera informs interested clients that have self-referred and/or clients and their doctors that have referred them  to her practice that her capacity is full and does her best to refer these folk on to her midwifery colleagues when possible, who are offering these services on the North Shore or in Vancouver.