Benefits to Women Needing Obstetrical Care: A Case for Sustaining Midwifery

Midwives provide high quality, cost-effective care to childbearing women throughout their pregnancy, birth, and in the post-partum period. As registered health professionals, midwives are highly trained. They are an accepted and integrated component of our health care and hospital systems.

Midwives became a regulated health profession in 1994. In 1999/2000, Ontario’s 176 midwives delivered 5,033 births. Today, there are approximately 366 midwives who are expected to deliver approximately 10,700 births this year. They are paid for an entire course of care rather than individual services.

With the growing evidence of an obstetrical care crisis, midwifery is a success story of women caring for women. The Ministry’s recent review of midwifery has determined that midwifery care is cost effective, has exceptional clinical outcomes and results in significantly high client satisfaction. Further, midwifery is a growing profession, and because it is a managed program, the province has the ability to direct spending to underserved areas across the province. Investing in midwifery is the most practical way to ensure that expectant mothers and babies get the quality care they need in their communities.

In August 2004, Minister Smitherman said, “What better way to invest our precious health care dollars than in support of the midwives who help to bring us such wonders.” The province has provided important support for the growth of midwifery, but midwifery is a demanding profession. The province now needs to also focus on sustaining the profession to allow more women to benefit from midwifery care.

Midwifery Model of Care

The needs of the mother and her baby are at the centre of the midwifery model of care. Midwives provide comprehensive maternity care to women having low risk pregnancies, based on the recognition that pregnancy is a natural, healthy process.

Midwives build a trust relationship with their clients, work with them to make informed choices about their care, and are accessible on-call 24/7. Women value the relationship they build with their midwife, which allows the midwife to provide individualized and responsive care.

According to the Canadian Institute for Health Information, pregnant women consistently give high priority to working with “known care providers.” A known care provider removes much of the anxiety from childbirth, and this often contributes to better outcomes, fewer costly interventions, reduced ER visits, and greater client satisfaction. Midwifery clients have proven strong advocates for midwifery care.

Client Centred and Community-Based Care

The midwifery model of care is driven by the needs of mothers and their newborns. Midwives provide around the clock access for their clients and plan care based on the woman’s needs and choices. Clients appreciate the high quality care midwives provide. A recent Ministry survey of clients found a 98.7% satisfaction rate with the care they received.

Midwives have been active proponents of collaboration with other health professionals around the needs of her clients. However, collaboration is still limited by barriers in the system, including compensation models that do not provide reasonable parity among the different members of the team.

Most of the care that midwives provide is in the community, creating significant savings for the health care system. This results in a high rate of client satisfaction, and significantly reduces the demand for hospital services. By being on-call around the clock for their clients, midwives reduce ER visits. As well, one in four clients give birth at home. For women who give birth in hospital, midwifery has shorter hospital stays including significantly higher early hospital discharge rates, lower re-admission rates, and a lower obstetrical intervention rates.

The community-based approach to midwifery care is a key element of the success of the model, and provides women with the kind of maternity care that they want. This has resulted in a demand for midwives’ services far exceeding the supply. Midwives are currently able to accommodate only 60% of women seeking midwifery care.

Quality Care

Midwives have demonstrated their ability to provide continuous, high quality care to healthy pregnant women and their newborns. Statistics gathered since 1994 have consistently shown that midwife-delivered babies are healthy and have less need for further hospitalization or medical attention.

The Ministry of Health and Long-Term Care’s program evaluation of midwifery found that compared to obstetrical care services provided to low-risk women by family doctors, midwifery resulted in lower obstetrical care intervention rates, including a 38% lower c-section rate and a 62% lower rate of instrument assisted births, nearly double the number of women discharged within 48 hours of birth, and lower maternal/newborn hospital readmission rates.

MOHLTC Program Evaluation Findings

The quality care that midwives provide is about much more than delivering babies. Midwives counsel, monitor and support the health of the mother from early in the pregnancy, through birth and the post-partum period. Continuity of care is an important aspect of midwifery care. The time midwives spend in education and support is an essential part of promoting a healthy pregnancy and lowering rates of intervention. In the weeks and months following birth, healthy mothers and newborns need to access the health care system less frequently, resulting in substantial savings by reducing visits to health care professionals.

Demanding Profession

Midwives are dedicated professionals who are committed to high quality client-centred maternity care. Providing this kind of care to pregnant women and their babies makes midwifery a demanding profession. Midwives have significant responsibilities for the women they care for, work long and irregular hours, and spend most of their time on-call. The excellent care that midwives provide to their clients often produces significant job-related stress. Providing the kind of care that delivers the excellent outcomes and significant cost savings for Ontario means midwives are limited in the time and energy they have to care for themselves and their families. Midwives are often unable to afford access to appropriate child care or other family supports to address this impact, as they are increasingly under compensated.

Over the last 10 years midwives have experienced substantial erosion in quality of life as costs of living have increased significantly without a rise in their income. Addressing this issue is essential for the sustainability and growth of the profession.

May 2007