Meeting the Needs of Uninsured Women: Informed Choice, Choice of Birthplace and the Work of Midwives in Ontario

This paper focuses on the work of a small group of Ontario midwives who provide care to women without health insurance. Specifically, we explore how midwives support uninsured clients as they navigate the decision over where to birth their babies. Informed choice and choice of birthplace are both core and fundamental tenants of the model of midwifery care in the province. For the small but growing number of women in midwifery care in Ontario who do not have health care coverage, the decision about where to deliver their baby is complicated by the need to consider the significant hospital bed fees which are associated with hospital birth. Our research explores how midwives navigate the complex issues which arise for women and their care providers when economic considerations enter into the decision making process with regards to birth place options. Based on interviews conducted with midwives who care for uninsured women in Ontario, the paper focuses on the provision of care in this unique context. Issues explored include; the provision of informed choice, inter- professional work, pushing boundaries and the advocacy work of midwives.