Table 1.

Definition of Key Terms Used in Article

Term	Definition
Admitting privileges	A midwife who has admitting privileges at a hospital is a member of the health care staff and can admit clients to that hospital and manage care. All midwives are required to have admitting privileges at one or more hospitals to allow for transfer from a planned home or birth center birth if required. Admitting privileges are granted based on hospital‐specific criteria and proof of licensure.
Appointment	Eligibility for a midwife to provide birth services to clients who meet the criteria for admission to the birth centers. At each Ontario birth center, midwives from multiple midwifery practice groups hold appointments at the facility.
Midwifery‐led birth center	A birth center developed and run by midwives for midwifery clients. There are no medical or nursing personnel on site, and care is provided totally by midwives with the assistance of birth center aides who help with equipment, cleaning, meals, etc. Typically, women will be admitted to a birth center in active labor, have 2 midwives attend the birth, and will be discharged at 4‐6 h postpartum. Ontario birth centers are regulated under the Independent Health Facilities Act with the College of Midwives of Ontario responsible for inspecting and assessing the facilities.15
Nonurgent transport	Examples of reasons for nonurgent transports from birth center to hospital include prolonged labor and pain management.
Transfer	The transfer of care responsibility from one health care provider to another (ie, midwife to physician), in which the accepting health care provider becomes most responsible for the care of the woman and/or newborn. Note that the College of Midwives of Ontario, the provincial regulatory body for the midwifery profession, sets the clinical standard of practice for consultation and transfer of care,16 so the opening of the 2 birth centers did not change transfer of care policies or practices.
Transport	The physical movement of a midwifery client from one location to another (ie, birth center to hospital), with or without the assistance of emergency medical services.
Urgent transport	Examples of reasons for urgent transports from birth center to hospital include the following: maternal complications such as hypertension, fever, or hemorrhage; fetal complications such as meconium or malpresentation; or newborn complications such as respiratory distress, low glucose, small for gestational age, or unexpected anomaly.
Urgent transport facility	A designated hospital to which to transport all women at a birth center requiring a higher level of care and a potential need for transfer of care from a midwife to a physician.