BC residents’ services are covered by a BC care card for a course of care  for midwives that provide a full course of care.  Since Vera is retired from 24/7 labor and birth work her prenatal and postpartum service is covered by a phase of care (1^st, 2^nd trimester and postpartum afterbirth care). She also undertakes work that is covered by midwives consultant and assessment fees.

Every BC healthy pregnant resident has the choice of a maternity doctor, or midwife for their prenatal, labor and birth care. Often it is challenging to get into a continuous service in the beginning of a pregnancy.  Vera’s practice is a bridge. Folk, who find themselves at the beginning of a pregnancy have the choice to undertake their first and second trimester prenatal care with a midwife, their family doctor, nurse practitioner or a walk-in-clinic physician until they have accessed an ongoing prenatal and labor and birth provider.  

Vera’s early prenatal clientele live on the North Shore.  Most have had no prenatal care, many do not have a family doctor and others have only had one prenatal visit with a family doctor, or walk in clinic physician. 

If you would like early prenatal care with a midwife and have an upcoming appointment with a doctor, you would need to cancel this appointment.  An exception is, if you have had only one visit with a doctor, before you discovered that there is an option to have your early prenatal care with a midwife. In this situation, Vera would email you a consent for release of medical records, so that you can arrange to have your test results, undertaken through your family doctor, NP or walk-in clinic and have your records faxed over to Vera’s office. Your doctor, NP or walk-in clinic would be informed that Vera is the most responsible provider for your early prenatal care. She will transfer your records and care to a midwife/doctor, who provides ongoing prenatal, labor and birth services. 

The midwifery model of care allows for 30 – 60minute appointments and pays midwives for a phase of early care that includes 2- 3 visits that are a mix of virtual and in person visits.  MSP does not allow double billing for the same service. 

Vera’s scheduled visits are 45-60 mins.  Requested additional telephone consultations are a shorter duration. She has a consultation fee of $140/hr private consultation rate. She also has an ad hoc $80 fee for requested uninsured services that are not covered by MSP.  Such as completion of proof of pregnancy letters, employment forms, forms to get ski passes refunded and/or off-work letters.  It also goes toward covering the admin cost of transferring care. 

Every prenatal client who enrols in Vera’s early prenatal care agrees to complete a MSP phase of care, which includes a midwife’s overhead allowance, or if they have no MSP to private pay for a phase of care, plus an ad hoc administration fee.

Private clients remunerate services rendered upfront. Their phase of care + admin fee is paid in advance  and will not be prorated or returned, in the situation that they leave care early.  

In the event that a  MSP client in care requests an earlier transfer of care prior to completing their last scheduled appointment in their phase of care.  Vera has a missed-appointment and admin fee. Clients with MSP, who want to miss scheduled appointments and be transferred elswhere before their phase ends will be invoiced  the ad hoc $80 admin fee +$140/visit fee for the missed scheduled visit to remunerate Vera for the service she provides and to off-set  service delivery costs

Vera provides clients in care the option to use the practice phone, text messaging service to request a phone consultation between their scheduled appointments.  This service is available to clients in her care between 9am in the morning and 11pm at night, 7 days a week, unless Vera has informed her current clientele of her unavailability due to a personal or professional need. Regular request for a telephone call is responded to within 4-6 hours or less. ‘Time sensitive telephone call requests are returned within 60 – 90mins or less of receipt of text message.

Should an unexpected urgent concern occur either during Vera’s availability hours and a client has been unable to connect in a timely way with Vera, or the concern occurred between 11pm and 9am. Clients are instructed to go to LGH emergency room. In this rare instance, Vera asks that a family let her know of this occurrence via her email, so that she can follow up on their care. Clients, who are uncertain that their concern warrants an ER visit can call the 24/7 provincial nurse line 811

Midwives and family doctors who provide maternity services, refer women with health issues outside of their scope of care to specialists.   In some circumstances, an obstetrician will share care 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 transfer care in these circumstances.  There are other specialists who provide care along side midwifery care, such as endocrinologists, gastroenterologists, psychiatrists, internal medicine specialists.  These doctors see pregnant folk during and after their pregnancies for the related health issue their expertise covers.  Pregnant folk can also see their family doctors during their care with a midwife, for a medical issue that is not related to pregnancy and that is outside of a midwife’s scope of practice for example antibiotics for sinusitis or bronchitis. Vera requests that her clientele keep her informed of any health circumstance that requires them to see a doctor.  

Folk, who do not have a family doctor that have a medical concern outside of a midwife’s scope of practice, Vera refers to doctors or nurse practitioners, who work in urgent care centers or walk in clinics

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 who have self-referred and doctors, who have referred clients that her capacity is full and refers these folk onto her midwifery North Shore or Vancouver colleagues, who offer similar services to those that Vera usually provides.

Midwives are primary caregivers of well pregnant folk during their whole pregnancy, labor, birth and postpartum. They are also primary caregivers of well newborns until 6-8 weeks postpartum and have expertise to assist parents with breastfeeding. Consequently, pregnant or postpartum folk do not see a doctor at the same time that they see a midwife for maternity care. 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 https://mycarecompass.lifelabs.com/ 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 your 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, family doctor or nurse practitioner, who provides pregnancy, postpartum and newborn care. Midwives, family doctors and nurse-practitioners 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. Vera provides her clients with a copy of their midwifery summary of care and their baby/babies growth chart.

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 urine pregnancy home test results, routine prenatal tests, including an ultrasound to accurately date your pregnancy and to reduce your 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 Down syndrome, trisomy 18, or an open neural tube defect.  Information about prenatal genetic screening options in BC can be obtained via Perinatal Services BC site http://www.perinatalservicesbc.ca/our-services/screening-programs/prenatal-genetic-screening

An informed decision making tool that may help you make a decision to undertake, or forego optional early genetic pregnancy testing can be found at this link : Prenatal Genetic Screening: Decision Aid

Vera Berard RM  aims to form a care partnership with each client who enrols into her prenatal or postpartum service. 

She undertakes all clinical and administrative work herself. Vera’s regular in-person office appointments are routinely scheduled only on Wednesday between 2pm-8pm at Shipyards Health, 88 Lonsdale Ave. Occasionally Vera can arrange space in Quayside Village at 5^th and Chesterfield Avenue to undertake an office in person visit. Most appointments are arranged and confirmed via email.

Vera has more flexibility with her prenatal and postpartum remote visits and in person home visits.

Prenatal clients receive a schedule of 2-3 appointments that are a mix of remote and in-person visits after enrolling into care for each phase of care Vera provides.

When a pregnant person chooses to come into early prenatal care, there are usually 2 initial appointments relatively close together, so that a history can be obtained, a physical examination be untaken and requisitions provided for all routine and optional tests. Ongoing prenatal care is transferred to a midwife or a doctor who undertakes labor and birth care 4-5 weeks after a client’s last scheduled visit with Vera that is either around 13 weeks (end of the first trimester) or around 25weeks (end of the 2^nd trimester)

Vera’s midwife colleagues on the North Shore with privileges at Lionsgate Hospital, Canopy Midwives  or Vancouver midwives with privileges at St Paul’s Hospital are pleased to accept her early pregnancy clients into their practices when they have capacity.  Lionsgate Maternity Clinic is a group of family practice doctors who provide prenatal, labor and birth care, who have a collaborative agreement with Vera that supports her alternate practice, now that she is retired from 24/7 labor and birth care. They will accept Vera’s early prenatal clients that prefer family practice care, or who were not able to access ongoing midwifery care.

When Vera’s clients access ongoing care, so that their care can be transferred seamlessly and there is no duplication of services.  It is important that they inform their ongoing prenatal,  labor and birth provider (midwife or doctor) that they are in Vera’s early prenatal services and arrange their appointment with their ongoing provider for 4-5 weeks after their last scheduled appointment with Vera.  After this has been accomplished, they then need to inform Vera the name of the provider they have accessed for their ongoing prenatal, labor and birth care and the date and time of their first appointment.  So that Vera can fax their records to their next provider’s office ahead of their first visit and transfer their care

Postpartum clients arrange their first home visit via email before they are discharged from hospital.   Next home visits in the first and 2^nd week after birth are arranged at the end of each visit.  The last 2 postpartum visits are usually scheduled inperson office appointments either at 4 and 6 weeks or 5 and 7 weeks postpartum. On average postpartum clients have 5-6 scheduled visits over the course of their postpartum care.

Vera’s visits are on average 45mins long with some visits being 30mins and others being 60-90 minutes depending on individual clients and their baby/babies needs. Clients can arrange an additional telephone consultation and/or in person visit when needed.