Outcomes for the First Year of Ontario's Birth Center Demonstration Project

Ae, Sprague; Sidney, Dana; Ek, Darling; Wagner, V.E.; Soderstrom, Bobbi; Rogers, Judy L.; Graves, Erin; Coyle, Diane; Sumner, Anne E.; Holmberg,; Khan, Bushra Tayyaba; Walker, Matthew C.

doi:10.1111/jmwh.12884

Cited by 10 publications

(14 citation statements)

References 24 publications

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“…Ontario has emerged as a leader in midwifery as it was the first province to regulate the profession, has the largest and most established workforce, and trains the most midwives in the country. Supportive evaluations from the first year of operations of the two birth centres have found that clients had significantly fewer interventions and care reflected current best practices [88]. The findings from the evaluation are consistent with research internationally and support the safety of midwife-led out-of-hospital births for low-risk populations [77][78][79]89].…”

Section: Discussionsupporting

confidence: 55%

Understanding the conditions that influence the roles of midwives in Ontario, Canada’s health system: an embedded single-case study

Mattison¹,

Lavis

Hutton³

et al. 2020

BMC Health Serv Res

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Background: Despite the significant variability in the role and integration of midwifery across provincial and territorial health systems, there has been limited scholarly inquiry into whether, how and under what conditions midwifery has been assigned roles and integrated into Canada's health systems. Methods: We use Yin's (2014) embedded single-case study design, which allows for an in-depth exploration to qualitatively assess how, since the regulation of midwives in 1994, the Ontario health system has assigned roles to and integrated midwives as a service delivery option. Kingdon's agenda setting and 3i + E theoretical frameworks are used to analyze two recent key policy directions (decision to fund freestanding midwifery-led birth centres and the Patients First primary care reform) that presented opportunities for the integration of midwives into the health system. Data were collected from key informant interviews and documents. Results: Nineteen key informant interviews were conducted, and 50 documents were reviewed in addition to field notes taken during the interviews. Our findings suggest that while midwifery was created as a self-regulated profession in 1994, health-system transformation initiatives have restricted the profession's integration into Ontario's health system. The policy legacies of how past decisions influence the decisions possible today have the most explanatory power to understand why midwives have had limited integration into interprofessional maternity care. The most important policy legacies to emerge from the analyses were related to payment mechanisms. In the medical model, payment mechanisms privilege physician-provided and hospital-based services, while payment mechanisms in the midwifery model have imposed unintended restrictions on the profession's ability to practice in interprofessional environments. Conclusions: This is the first study to explain why midwives have not been fully integrated into the Ontario health system, as well as the limitations placed on their roles and scope of practice. The study also builds a theoretical understanding of the integration process of healthcare professions within health systems and how policy legacies shape service delivery options.

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Section: Discussionsupporting

confidence: 55%

Understanding the conditions that influence the roles of midwives in Ontario, Canada’s health system: an embedded single-case study

Mattison¹,

Lavis

Hutton³

et al. 2020

BMC Health Serv Res

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“…In the first year of operations of the 2 birth centers, we observed a transfer rate of 26.3% (130 transfers out of 495 admissions), 18 which was higher than the transfer rate of our survey sample. It is unknown why the transfer rate of our survey sample is lower than the overall birth center–hospital transfer rate for the corresponding period.…”

Section: Discussioncontrasting

confidence: 81%

“…Although the self‐reported rates of assisted vaginal births and cesarean births were higher in the hospital group in our study, this could be due to underlying factors in self‐selection for a hospital birth. More discussion of these outcomes can be found in our previous work that included a matched control group 18 …”

Section: Discussionmentioning

confidence: 99%

“…The opening of the birth centers provided the opportunity to complete a comprehensive evaluation. The overall mixed‐methods study examined the implementation of the birth center demonstration project in the 2 cities and assessed the clinical activities and outcomes for the first year, 18 health care provider experiences, 19 and client experiences (which we report here). We demonstrated that the birth centers are a safe and effective option for women with low‐risk pregnancies seeking a low‐intervention approach to their labor and birth 18 .…”

Section: Introductionmentioning

confidence: 99%

“…The overall mixed‐methods study examined the implementation of the birth center demonstration project in the 2 cities and assessed the clinical activities and outcomes for the first year, 18 health care provider experiences, 19 and client experiences (which we report here). We demonstrated that the birth centers are a safe and effective option for women with low‐risk pregnancies seeking a low‐intervention approach to their labor and birth 18 . In addition, we found that the process used to plan and implement the birth centers facilitated integration of the centers into the existing maternal‐newborn health system and increased opportunities for interprofessional collaboration 19 …”

Section: Introductionmentioning

confidence: 99%

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Client Experience with the Ontario Birth Center Demonstration Project

Reszel

Weiß

Darling

et al. 2020

J Midwife Womens Health

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Introduction In 2014, 2 new freestanding midwifery‐led birth centers opened in Ontario, Canada. As one part of a larger mixed‐methods evaluation of the first year of operations of the centers, our primary objective was to compare the experiences of women receiving midwifery care who intended to give birth at the new birth centers with those intending to give birth at home or in hospital. Methods We conducted a cross‐sectional survey of women cared for by midwives with admitting privileges at one of the 2 birth centers. Consenting women received the survey 3 to 6 weeks after their due date. We stratified the analysis by intended place of birth at the beginning of labor, regardless of where the actual birth occurred. One composite indicator was created (Composite Satisfaction Score, out of 20), and statistical significance (P < .05) was assessed using one‐way analysis of variance. Responses to the open‐ended questions were reviewed and grouped into broader categories. Results In total, 382 women completed the survey (response rate 54.6%). Half intended to give birth at a birth center (n = 191). There was a significant difference on the Composite Satisfaction Scores between the birth center (19.4), home (19.5), and hospital (18.9) groups (P < .001). Among women who intended to give birth in a birth center, scores were higher in the women admitted to the birth center compared with those who were not (P = .037). Overall, women giving birth at a birth center were satisfied with the learners present at their birth, the accessibility of the centers, and the physical amenities, and they had suggestions for minor improvements. Discussion We found positive experiences and high satisfaction among women receiving midwifery care, regardless of intended place of birth. Women admitted to the birth centers had positive experiences with these new centers; however, future research should be planned to reassess and further understand women's experiences.

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