Thankyou for the endless support, wisdom and advice through the last 7 months. It was with your help we were able to bring a healthy and wonderful baby into this world.
- With Love. Rachel December, 2021
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North Vancouver, BC V7M 2L9
Skilled, regulated & integrated perinatal services on the North Shore that is covered by MSP for BC residents. Private fees available for newcomers.
Now offering Initial Prenatal Care, After Birth Postpartum Care, including Infant Feeding, Infant Development, C-Section Recovery, Contraception and Early Parenting Education only.
Labor and Birth services are indefinitely on-hold.
When enrolled in my care, we would arrange an in-person office appointment toward the end of your pregnancy, to plan and prepare how to meet your after birth needs. When you are in hospital, you would then inform me that your baby has been born. So that I can put you into my Thursday through Tuesday home visiting schedule. My postpartum services would then begin in your home on the first or second day after you and your baby have been discharged from hospital.
As long as you live in my catchment area, have had no or minimal prenatal care from a doctor, you are eligible for my MSP covered early prenatal services. I have a private fee for folk new to BC without a care card.
Regardless of whether you have an uncomplicated health history, have conceived spontaneously and confirmed your pregnancy with a home urine test; or if you conceived with the aid of reproductive medicine:
If you have little, or no health issues, have had a prior healthy pregnancy that ended with a caesarean-section, and have yet to have initial early prenatal care.
I begin care with a remote visit usually scheduled on a Wednesday morning. In-person visits are scheduled in Shipyards Health in Lower Lonsdale on Wednesday afternoon between 2pm – 8pm. My early prenatal clients usually transfer ~ 4 weeks after their last appointment with me, which is usually between 10 – 13 weeks, or between 21- 24weeks for ongoing prenatal, labor and birth care to either a midwifery practice or to Lionsgate maternity care family doctors . In the event that a complication is found in an early pregnancy, a client is transferred to an obstetrician-gynaecologist colleague.
Any time a person is early pregnant there is a 3 in 4 chance that the pregnancy grows well and a 1 in 4 chance that there is a miscarry. I am there to provide support in the event of a miscarriage and if needed can refer to an OBGYN.
Vera understands how important peace of mind can be during a new and unfamiliar period of your life. That’s why her clients in care can contact her 7 days a week between 8am and midnight via her email paging system. She aims to respond within 4-6 hours when she receives a request for a regular telephone call and has a process her clients can use for time-sensitive calls that she responds to within an hour. Clients that have an urgent concern between midnight and 8am are instructed to call 811 and to go to LGH ER.
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.
Vera has an email app on her phone that clients can access between 8am in the morning and midnight, 7 days a week. They insert ‘Telephone call requested’ in the subject line and in the content of the email, they put their telephone number and name. They ensure that their ringer is on. Vera responds to regular telephone requests within 3-6 hours or sooner. This request enables her to choose when she she responds to a telephone request. If a client indicates ‘Urgent telephone call requested’, these requests are returned within an hour. Vera’s clients have the ablity to decide on the time-response to their request.
Between midnight and 8am, clients are instructed to call 811 and/or to go to LGH emergency, should they have an unexpected urgent concern.
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.
What 8217 s a midwife to do when 24 hour 7 day labor and birth work is no longer feasible Look forward to connecting with as many postpartum families after the birth of their babies and or to newly pregnant folk as my part time capacity allows Initial Early Pregnancy Care and After Birth Postpartum and Newborn Care hellip
It s been just over a year since Midwifery Care North Shore has ONLY been offering partial midwifery services in the form of early pregnancy care and postpartum services While it has been a change it has also been a natural progression Vera Beard RM has embraced the many joys of providing services to folk just hellip
MIDWIFERY CARE NORTH SHORE 24hour 7day services are temporarily on hold to potential clients that are looking for labor and birth services the end of 2021 onwards We are waiting for VCH LGH to post midwifery hospital privileges and for midwives interested in working in an individual and group care model to be able to join Vera hellip
Despite COVID challenges MCNS current 2020 2021 team of two Vera Berard and Erika Mitchell have been delighted to be with laboring folk attending their births and welcoming their babies Life continues folk get pregnant and babies get born between February 2020 and March 2021 Midwifery Care North Shore has provided care to approximately 58 families hellip
We are happy to reiterate that Vera and team continue to welcome clients into a partnership of care despite now needing to live with COVID pandemic processes as a part of daily life We are currently welcoming clients looking for midwifery services that are due from December 2020 onwards Please look at our update below hellip
Winter and spring certainly have brought much change and uncertainty for all of us Our world on the North Shore and elsewhere is different We are happy to say that Vera and team continue to welcome clients into a partnership of care despite now needing to live with COVID pandemic processes as a part of hellip
Thankyou for the endless support, wisdom and advice through the last 7 months. It was with your help we were able to bring a healthy and wonderful baby into this world.
- With Love. Rachel December, 2021
Regulated and experienced midwifery care on the North Shore.
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