A midwife new to a practice has been asked to review the client intake forms that have been completed by potential clients looking for midwifery care. The first form the midwife reviews was submitted by a client who had one previous vaginal birth. This potential client notes that she may have one risk factor as a previous care provider told her that her BMI puts her at risk during pregnancy and birth. The client then follows up with the practice and asks if her BMI is a risk factor and if your practice will take her into care?
What does the midwife need to know in order to consider this?
The midwife must know the practice’s intake process, which should be easy to understand and available to potential clients (e.g., posted on the website). The steps in the process, such as whether an in-person or virtual visit is part of the process of determining eligibility for midwifery care, should be included in the information available to clients in addition to any criteria that are used to determine suitability. These criteria may consider the level of care the client requires or expects, and the competencies of each midwife in the practice.
An intake process may also consider whether the practice has access to the resources to manage the client’s care, or to consult or transfer care when needed. Where one practice is in a community where they do not have access to the care clients need, another practice may be in a community where they provide care in collaboration with physicians who manage the elements of care outside of the midwifery scope. Because midwifery care usually includes prenatal, intrapartum, postpartum, and newborn care, an intake process that routinely declines clients because they may require a transfer of care for birth may not be reasonable.
Midwives are bound by the Ontario Human Rights Code, 1990 which means midwives and practices cannot deny care to clients based on characteristics or circumstances under the code such as age, disability, race, or religion. A midwife or midwifery practice also must not turn down clients who require more time or attention due to their physical or social circumstances. In considering whether to accept a client into care, the midwife must adhere to the principles of the Ontario Human Rights Code where every person is entitled to access and receive health care services in a manner that respects their human rights.
Making assumptions about a person’s health or abilities because of their age or another prohibited reason, rather than based on clinical observation or professional knowledge and experience, is considered discrimination even if this is not the intent of the midwife or the practice’s intake process.
Therefore, client intake processes should accept and decline potential clients in a way that applies to all prospective clients equally and should be made in good faith. In a scenario like this, it may not be reasonable to deny care based solely on a client’s BMI.
If you do not accept a prospective client into your practice, it is important to discuss your decision with them honestly and courteously and record this discussion in your files, so you have a reference for ensuring the practice is making consistent decisions regarding accepting and refusing clients into care.
Finally – it is important that all members of the practice, including practice administrators, are aware of the client intake process so they can clearly communicate and manage the expectations of all prospective clients.