Skip to main content
NCBI home page
Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2000 Jan 1;91(1):I5–I11. doi: 10.1007/BF03404260

Comparison of Midwifery Care to Medical Care in Hospitals in the Quebec Pilot Projects Study: Clinical Indicators

William Fraser 117,✉, Marie Hatem-Asmar 217, Isabelle Krauss 217, Françoise Maillard 317, Gérard Bréart 317, Régis Blais 417, Johanne Collin 517, André-Pierre Contandriopoulos 517, Maria De Koninck 517, Andrée Demers 517, Pierre Joubert 517, Deena White 517, Francine Desbiens 517, Claude Gagnon 517, Daniel Reinharz 517
PMCID: PMC6980069  PMID: 10765581

Abstract

The purpose of this study was to compare indicators of process and outcome of midwifery services provided in the Quebec pilot projects to those associated with standard hospital-based medical services. Women receiving each type of care (961 per group) were matched on the basis of socio-demographic characteristics and level of obstetrical risk. We found midwifery care to be associated with less obstetrical intervention and a reduction in selected indicators of maternal morbidity (caesarean section and severe perineal injury). For neonatal outcome indicators, midwifery care was associated with a mixture of benefits and risks: fewer babies with preterm birth and low birthweight, but a trend toward a higher stillbirth ratio and more frequent requirement for neonatal resuscitation. The study design does not permit to conclude that the associations were causal in nature. However, the high stillbirth rate observed in the group of women who were selected for midwife care raises concerns both regarding the appropriateness of the screening procedures for admission to such care and regarding the quality of care itself.

Footnotes

This study was funded by the Quebec Ministry of Health and Social Services.

One of four peer-reviewed papers in a paid insert to the Canadian Journal of Public Health.

References

  • 1.WHO. Appropriate technology for birth. Lancet. 1985;2(8452):436–37. [PubMed] [Google Scholar]
  • 2.Albers L, Katz V. Birth setting for low-risk pregnancies: An analysis of the current literature. J Nurse Midwifery. 1991;36(4):215–20. doi: 10.1016/0091-2182(91)90081-Y. [DOI] [PubMed] [Google Scholar]
  • 3.Feldman E, Hurst M. Outcomes of procedures in low-risk birth: A comparison of hospital and birth center settings. Birth. 1987;14(1):18–24. doi: 10.1111/j.1523-536X.1987.tb01444.x. [DOI] [PubMed] [Google Scholar]
  • 4.Mayes F, Oakley D, Wramseh B, et al. A retrospective comparison of CNM and physician management of low-risk births: A pilot study. J Nurse Midwifery. 1987;32(4):216–22. doi: 10.1016/0091-2182(87)90113-3. [DOI] [PubMed] [Google Scholar]
  • 5.Campbell R, MacFarlane A. Where to be Born? Oxford: National Perinatal Epidemiology Unit; 1994. [Google Scholar]
  • 6.Flint C, Poulangeris P, Grant A. The ‘Know Your Midwife’ scheme–a randomised trial of continuity of care by a team of midwives. Midwifery. 1989;5:11–16. doi: 10.1016/S0266-6138(89)80059-2. [DOI] [PubMed] [Google Scholar]
  • 7.MacVicar J, Dobbie G, Owen-Johnstone L, et al. Simulated home delivery in hospital: A randomised controlled trial. Br J Obstet Gynaecol. 1993;100:316–23. doi: 10.1111/j.1471-0528.1993.tb12972.x. [DOI] [PubMed] [Google Scholar]
  • 8.Kenny P, Brodie P, Eckerman S, Hall J. Westmead Hospital team midwifery project evaluation. Westmead, South Wales, Australia: Centre for Health Economics Research and Evaluation, Westmead Hospital; 1994. [Google Scholar]
  • 9.Rowley MJ, Hensley MJ, Brinsmead MW, Wlodarczyk JH. Continuity of care by a midwife team versus routine care during pregnancy and birth: A randomised trial. Med J Aust. 1995;163:289–93. doi: 10.5694/j.1326-5377.1995.tb124592.x. [DOI] [PubMed] [Google Scholar]
  • 10.Turnbull D, Holmes A, Shields N, et al. Randomised, controlled trial of efficacy of midwife-managed care. Lancet. 1996;348:213–18. doi: 10.1016/S0140-6736(95)11207-3. [DOI] [PubMed] [Google Scholar]
  • 11.Harvey S, Jarrell J, Brant R, et al. A randomized, controlled trial of nurse-midwifery care. Birth. 1996;23:128–35. doi: 10.1111/j.1523-536X.1996.tb00473.x. [DOI] [PubMed] [Google Scholar]
  • 12.Waldenström U, Nilsson CA. A randomised controlled study of birth care versus standard care: Effects of women’s health. Birth. 1999;24:17–26. doi: 10.1111/j.1523-536X.1997.00017.pp.x. [DOI] [PubMed] [Google Scholar]
  • 13.Waldenström U, Turnbull D. A systematic review comparing continuity of midwifery care with standard maternity services. Br J Obstet Gynaecol. 1998;105:1160–70. doi: 10.1111/j.1471-0528.1998.tb09969.x. [DOI] [PubMed] [Google Scholar]
  • 14.Pocock SJ. Clinical Trials: A Practical Approach. Chichester, England: A Wiley Medical Publication; 1983. [Google Scholar]
  • 15.Blais R, Joubert P. Evaluation of the midwifery pilot projects in Quebec: An overview. Can J Public Health. 2000;91(1):I1–I4. doi: 10.1007/BF03404259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Coopland AT, Peddle LJ, Baskett TF, et al. A simplified antepartum high-risk pregnancy scoring form. CMAJ. 1977;116:999–1001. [PMC free article] [PubMed] [Google Scholar]
  • 17.Hannah ME, Hannah WJ, Hellmann J, et al. Induction of labour as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. N Engl J Med. 1992;326:1587–92. doi: 10.1056/NEJM199206113262402. [DOI] [PubMed] [Google Scholar]
  • 18.Saari-Kemppainen A, Karjalainen O, Ylostalo P, Heinonen O. Ultrasound screening and perinatal mortality: Controlled trial of systematic one-stage screening in pregnancy, the Helsinki ultrasound trial. Lancet. 1990;336:387–91. doi: 10.1016/0140-6736(90)91941-3. [DOI] [PubMed] [Google Scholar]
  • 19.Ewigman BG, Crane JP, Frigoletto FD, et al. Effect of prenatal ultrasound screening on perinatal outcome. N Engl J Med. 1993;329:821–27. doi: 10.1056/NEJM199309163291201. [DOI] [PubMed] [Google Scholar]
  • 20.Stephenson MJ. Screening for gestational diabetes mellitus: A critical review. J Family Practice. 1992;37(3):277–83. [PubMed] [Google Scholar]
  • 21.Rooks JP, Weatherby NL, Ernst EK, et al. Outcomes of care in birth centres. N Engl J Med. 1989;321:1804–10. doi: 10.1056/NEJM198912283212606. [DOI] [PubMed] [Google Scholar]
  • 22.Robinson S. The role of midwife: Opportunities and constraints. In: Chalmers E K, editor. Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press; 1989. pp. 162–80. [Google Scholar]
  • 23.Sultan AH. Anal incontinence after childbirth. Current Opinion in Obstet and Gynecol. 1997;9:320–24. doi: 10.1097/00001703-199710000-00010. [DOI] [PubMed] [Google Scholar]
  • 24.Bryce RL, Stanley FJ, Garner JB. Randomized controlled trial of antenatal social support to prevent preterm birth. Br J Obstet Gynaecol. 1991;98(10):1001–8. doi: 10.1111/j.1471-0528.1991.tb15338.x. [DOI] [PubMed] [Google Scholar]
  • 25.Villar J, Farnot U, Barros F, et al. A randomized trial of psychosocial support during high-risk pregnancies. The Latin American Network for Perinatal and Reproductive Research. N Engl J Med. 1992;327(18):1266–71. doi: 10.1056/NEJM199210293271803. [DOI] [PubMed] [Google Scholar]
  • 26.MacDonald D, Grant A, Sheridan-Pereira M, et al. The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring. Am J Obstet Gynecol. 1985;152(5):524–39. doi: 10.1016/0002-9378(85)90619-2. [DOI] [PubMed] [Google Scholar]
  • 27.Collin J, Blais R, White D, et al. Can J Public Health. 2000. Integration of midwives into the Quebec health care system. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Conseil d’évaluation des technologies de la santé du Québec. Les mortinaissances dans le cadre des projets-pilotes de la pratique des sages-femmes au Québec. Montréal: Conseil d’évaluation des technologies de la santé du Québec; 1999. [Google Scholar]

Articles from Canadian Journal of Public Health = Revue Canadienne de Santé Publique are provided here courtesy of Springer

RESOURCES