Comparing Women's Assessment of Midwifery and Medical Care in Québec, Canada

Abstract

In 1990, the province of Québec, Canada, adopted a law that authorized the evaluation of the practice of midwifery through pilot projects before its legalization. A key objective of this evaluation, as defined by the law, was the documentation of women's assessment of maternity care, especially with regard to humanization and continuity of care. Two to 3 months after birth, 933 midwifery clients and 1,000 physicians' clients, matched on several characteristics, responded to a mailed questionnaire (response rates were 93% and 76%, respectively). Results showed that women from both groups were generally satisfied with the care they received, although women who received midwifery care were assessed as more positive on every issue surveyed. Objective measures supported impressions that were also confirmed through qualitative data analysis: midwifery clients had a greater number of and longer prenatal visits, their care was perceived to be more personalized, and a greater number of midwives' clients breastfed their infants. However, the interpretation of these results must take into account that the two groups had different personal expectations and values with regard to health and health care. These findings are enlightening in evaluating women's needs, expectations, and satisfaction with health care services and should be included in future development of maternity care, including idwifery services, in Québec and other locations.

The facilitating factors and barriers encountered in the adoption of a humanized birth care approach in a highly specialized university affiliated hospital

“…Our findings are similar to those of De Koninck et al (2001), in that approximately 88.5% of physicians' clients of in Quebec hospitals indicated that they wished to deliver in the same setting for birthing if they became pregnant again [22]. …”

“…The self-administered questionnaire that we used had been developed in the context of a study that assessed midwifery practice in Quebec, comparing it to the standard obstetrical care provided in the province [22]. The questionnaire was adapted for the needs of the present study and was written in both English and French.…”

“…Finally, the questionnaire also contained some additional personal and socio-demographic questions. The reliability of the questionnaire have been assessed by Cronbach's Alphas; its values ranged from 0.71 to 0.93 [22]. …”

Introducing Midwifery-led Birth Centres to Ontario

“…Both quantitative and qualitative data were collected to evaluate the pilot. Results suggest that compared to physician services, midwifery clients were more satisfied and empowered by the care they received, midwifery was associated with greater continuity of care, and midwifery care was associated with fewer obstetrical interventions (Blais & Joubert 1999;Collin et al 1999;De Koninck et al 2001;Fraser et al 1999). An important finding stemming from the research was that of cost-effectiveness.…”

Step 1: Offers All Birthing Mothers Unrestricted Access to Birth Companions, Labor Support, Professional Midwifery Care

“…Quality: B Quantity: B Consistency: B Women cared for by professional midwives report increased satisfaction in the following areas (De Koninck, 2001;Harvey, 2002;Hodnett, 2000;Hundley, 1997;Oakley, 1995;Shields, 1998;Turnbull, 1996): Professional midwifery care reduces costs when compared with physicians working with similar populations for the following reasons (Blanchette, 1995;Carr, 2000;Harvey, 1996;Oakley, 1995;Oakley, 1996;Turnbull, 1996) …”