Delivering excellence: Inside WLMH’s groundbreaking hospitalist midwifery program
When Lauren Fortuna gave birth to her son Luca in early May at Hamilton Health Sciences’ (HHS) West Lincoln Memorial Hospital (WLMH), she wasn’t just continuing a family tradition—she was experiencing the benefits of a brand-new approach to maternity care. Fortuna, who was also born at WLMH and grew up in Grimsby, received support from a hospitalist midwife, part of a new program that is reshaping birth care in West Niagara.
Baby Luca was born at West Lincoln Memorial Hospital after a managed induction with the help of the hospitalist midwife.
The hospitalist midwifery program at WLMH is one of the first of its kind in the province at a small community hospital. It was the vision of Pilar Chapman, a registered midwife who saw the need for a new model of care that would support families, providers, and the hospital system itself. The program is funded through the Ontario Ministry of Health Extended Midwifery Care Model.
“The care at West Lincoln is really a hidden gem.”
“This role bridges the gap between traditional midwifery and hospital-based medicine,” says Chapman, who led the successful application for funding. “Midwives provide consistent, comprehensive care at West Lincoln.”
Midwives work at the hospital in 12-hour shifts from 6 a.m. to 6 p.m. and they staff a daytime newborn care outpatient clinic for patients who don’t have a health-care provider in the local community. In June, hours are expanding until midnight, and starting this fall, the hospitalist midwives will be on-site 24 hours a day, seven days a week.
What is a midwife?
Hospitalist Midwife Pilar Chapman conceived of the program and successfully applied for ongoing funding.
Midwives are health-care professionals who specialize in pregnancy, birth, and postpartum care. They offer personalized support, education, and medical expertise, with a focus on low-risk birth. In Ontario, midwives are highly trained and regulated by the College of Midwives of Ontario. They can order lab tests, perform deliveries, and provide newborn care.
Unlike community midwives who follow a specific group of clients throughout pregnancy, birth, and postpartum, a hospitalist midwife works in the hospital full-time, offering care to any patient who needs it during labor and delivery, whether they are under the care of an obstetrician, family physician or community midwife.
“This role bridges the gap between traditional midwifery and hospital-based medicine.”
Hospitalist midwives collaborate with nursing staff, write orders and manage patients. Hospitalist midwives update the patient’s main health-care provider throughout the labour process, allowing them to continue their own work until needed, and they remain part of the process. For instance, a family doctor could continue care at their clinic, or an obstetrician-gynecologist could be performing surgery. The primary care provider would come to the hospital unit to attend the baby’s birth.
Why hospitalist midwifery?
For WLMH, which reopened its obstetrical unit in October 2022 after a three-year closure due to COVID and surgical room issues, the timing was perfect.
Stephanie Skeldon, clinical manager of obstetrics and newborn services at WLMH.
“As we reopened, we wanted to offer a model that was sustainable and provided the highest level of care,” says Stephanie Skeldon, clinical manager of obstetrics and newborn services at WLMH. “The hospitalist midwife role brings the best of both worlds — midwifery expertise and seamless integration into hospital workflows.”
This model will provide 24/7 in-hospital midwifery coverage, supporting patients through early labor, assessments, and postpartum transitions, while also helping staff manage busy periods without having to immediately page the on-call obstetrician.
“Hospitalist midwives are an additional staffing resource in a specialized provider role,” explains Skeldon. “They’re here on the unit, supporting nurses, helping with decision-making, and improving the flow of care.”
Meeting growing needs
West Niagara is one of Ontario’s fastest-growing regions, and birth numbers at WLMH reflect that. More than 400 babies were born at the hospital in 2024, with numbers projected to increase as young families settle in the area and the hospital adds obstetricians and midwives to its staff.
“We’re projecting well over 500 births for 2025 based on the referrals we have so far,” says Skeldon. Prior to the closure in 2019, more than 800 babies were born at WLMH each year and the staff expect to be supporting this birth volume again soon.
Having a hospitalist midwife on site means these growing numbers can be supported with timely, patient-centered care.
Residents of the Niagara West area are also looking forward to care when the new WLMH building opens later this fall.
A positive birth experience
Lauren Fortuna, seen here with her spouse and baby Luca, received care from hospitalist midwife Pilar Chapman at West Lincoln Memorial Hospital.
Fortuna recalls her birth experience with warmth and gratitude. After starting the induction process at the hospital, she went home, then came back early the next morning for the next part of the induction process, labored, had an epidural, and had her baby before the end of Chapman’s shift. Chapman managed her induction and labour while updating Fortuna’s obstetrician, who was running a prenatal clinic in another area of the hospital at the same time.
“Pilar was great because she was guiding me through everything and working with all the nurses and answering my questions,” says Fortuna. “She was always checking in on me and chatting and laughing, and it was the best experience. The care at West Lincoln is really a hidden gem.”
Her experience highlights some of the program’s biggest strengths: continuity and presence. The hospitalist midwife can remain focused and present with patients throughout the birth process.
“Pilar even knew my Aunt Jean who had been a nurse at West Lincoln for 40 years,” says Fortuna. “And my husband and I knew some of the nurses and other patients who had their babies there. It’s a really connected community. Every single person I’ve talked to that has delivered at West Lincoln has said that care there is exceptional. And I agree.”
Skeldon says patients love the model. “We have a patient experience dashboard and I can go on there on a regular basis and see a lot of positive patient experience comments. And one of the ones that I read most recently was that a patient said, ‘I love how the midwives and nurses work together to provide the care that is needed with collaboration and trust.’”
Benefits for patients, staff and physicians
The advantages of the hospitalist midwifery model ripple throughout the health-care system:
- Patients and families benefit from consistent, comprehensive care from experienced professionals who specialize in normal birth and early postpartum needs.
- Hospital staff and physicians, including obstetricians and emergency room doctors, are supported by having a midwife on site who can handle assessments, monitor labor progress, and identify when physician involvement is needed.
“We don’t have a Pediatrics team or a NICU here at West Lincoln and so one of the things that this hospitalist midwife program has brought to us is that expertise in neonatal resuscitation and then providing that support to the nursing staff as well,” says Skeldon. “Prior to this program, the nurses were the first responders to any kind of neonatal resuscitation and then we would lean on the ER doctor or the anesthesiologist.”
For midwives who prefer not to be on call, now they have the option to work in a hospital setting where they can still manage labour, birth and early postpartum care while working for the hospital instead of a community-based practice.
Dr. Joan Bellaire, medical director of WLMH and HHS chief of family medicine agrees.
“The new midwife hospitalist program at WLMH speaks volumes in the dedication that our hospital, midwives, nursing and obstetrical staff commit in providing compassionate, responsive, team- based care for our pregnant patients receiving care at WLMH,” she says. “Pilar Chapman effectively leads this vision by her initiative, her passion and skill of low-risk obstetrical care and strong ability to lead in sustaining and supporting excellence in obstetrical standard of care as midwife site lead at WLMH.”
Benefits for the system
Chapman and Skeldon work together closely to run the new hospitalist midwifery program.
The hospital system sees improved health outcomes such as more early discharges with strong postpartum support, and reduced strain on emergency services. At WLMH, the early discharge rate has increased with the hospitalist midwife model. There was a jump in early supported discharge (less than 24 hours in the hospital) from 25 per cent to 43 per cent once the hospitalist midwife role was introduced in September 2024.
WLMH also has a high rate of success with vaginal birth after a cesarean section for subsequent babies which is expected to continue or increase under this model.
As well, the hospitalist midwife helps mentor new labor and delivery nurses, building confidence and skill in the next generation of caregivers.
“We’re really seeing the power of this model,” says Skeldon. “We can now keep more births close to home, and provide support to newborns and postpartum patients after they go home, when community resources like family doctors are unavailable.”
Looking ahead
Early feedback from families and staff has been overwhelmingly positive.
Chapman believes this model has the potential to be replicated in level-one hospitals across the province.
“We’re offering care that is evidence-based, deeply human, and sustainable,” she says. “That’s the future of maternity care in Ontario.”
For parents like Fortuna, that future is already here. And it’s bright, compassionate, and born at WLMH.
