Abstract
BackgroundThe aim of this study was to determine the characteristics of women in Canada who received care from a midwife during their prenatal period.MethodsThe findings of this study were drawn from the Maternity Experiences Survey (MES), which was a cross-sectional survey that assessed the experiences of women who gave birth between November 2005 and May 2006. The main outcome variable for this study was the prenatal care provider (i.e. midwife versus other healthcare providers). Demographic, socioeconomic, as well as health and pregnancy factors were evaluated using bivariate and multivariate models of logistic regression.ResultsA total of 6421 participants were included in this analysis representing a weighted total of 76,508 women. The prevalence of midwife-led prenatal care was 6.1%. The highest prevalence of midwife-led prenatal care was in British Columbia (9.8%), while the lowest prevalence of midwife-led prenatal care was 0.3% representing the cumulative prevalence in Nova Scotia, Prince Edward Island, Newfoundland and Labrador, New Brunswick, Saskatchewan, and Yukon. Factors showing significant association with midwife-led prenatal care were: Aboriginal status (OR = 2.26, 95% CI: 1.41–3.64), higher education with bachelor and graduate degree attainment having higher ORs when compared to high-school or less (OR = 2.71, 95% CI: 1.71–4.31 and OR = 3.17, 95% CI: 1.81–5.55, respectively), and alcohol use (OR = 1.63, 95% CI: 1.17–2.26). Age, marital status, immigrant status, work during pregnancy, household income, previous pregnancies, perceived health, maternal Body Mass Index (BMI), and smoking during the last 3 months of pregnancy were not significantly associated with midwife care.ConclusionsIn general, women who were more educated, have aboriginal status, and/or are alcohol drinkers were more likely to receive care from midwives. Since MES is the most recent resource that includes information about national midwifery utilization, future studies can provide more up-to-date information about this important area. Moreover, future research can aim at understanding the reasons that lead women to opt for midwife-led prenatal care.
Highlights
The aim of this study was to determine the characteristics of women in Canada who received care from a midwife during their prenatal period
Multivariate logistic regression analysis showed that the significant factors associated with receiving care from a midwife were: Aboriginal status (OR = 2.26, 95% 95% Confidence Interval (CI): 1.41–3.65), bachelor and graduate degree attainment when compared to high-school or less (OR = 2.71, 95% CI: 1.71–4.31 and Odds Ratio (OR) = 3.17, 95% CI: 1.81–5.55, for bachelor and graduate level, respectively), and self-reported alcohol use (OR = 1.63, 95% CI: 1.17–2.26) (Table 1)
In conclusion, receiving prenatal care from a midwife in Canada is associated with increased education, having an aboriginal status, and consuming alcohol during pregnancy
Summary
The aim of this study was to determine the characteristics of women in Canada who received care from a midwife during their prenatal period. While different combinations of midwife-led continuity, medical-led and shared models of care exist in some developed countries (e.g. Australia, New Zealand, the Netherlands, the United Kingdom and Ireland), medical doctors remain the primary care providers for the majority of childbearing patients in North America [3]. A Cochrane review performed in 2015 showed that patients of midwife-led continuity model of care (where the midwife is the primary care provider from initial booking until the end of the post-natal period) were less likely to experience the following as compared to other models of care (including obstetrician provided care, family doctor provided care, and shared care): epidural/ spinal analgesia, forceps/vacuum vaginal birth, preterm births, amniotomy, episiotomy, fetal loss and neonatal death [3]. The midwife-led continuity model shows a trend towards cost-effectiveness when compared to the medical-led care [3]
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