The Integration of Ontario Birth Centers into Existing Maternal‐Newborn Services: Health Care Provider Experiences

Abstract

IntroductionIn 2014, 2 freestanding, midwifery‐led birth centers opened in Ontario, Canada. The purpose of this study was to qualitatively investigate the integration of the birth centers into the local, preexisting intrapartum systems from the perspective of health care providers and managerial staff.MethodsFocus groups or interviews were conducted with health care providers (paramedics, midwives, nurses, physicians) and managerial staff who had experienced urgent and/or nonurgent maternal or newborn transports from a birth center to one of 4 hospitals in Ottawa or Toronto. A descriptive qualitative approach to data analysis was undertaken.ResultsTwenty‐four health care providers and managerial staff participated in a focus group or interview. Participants described positive experiences transporting women and/or newborns from the birth centers to hospitals; these positive experiences were attributed to the collaborative planning, training, and communication that occurred prior to opening the birth centers. The degree of integration was dependent on hospital‐specific characteristics such as history, culture, and the presence or absence of midwifery privileging. Participants described the need for only minor improvements to administrative processes as well as the challenge of keeping large numbers of staff updated with respect to urgent transport policies. Planning and opening of the birth centers was seen as a driving force in further integrating midwifery care and improving interprofessional practice.DiscussionThe collaborative approach for the planning and implementation of the birth centers was a key factor in the successful integration into the existing maternal‐newborn system and contributed to improving integrated professional practice among midwives, paramedics, nurses, and physicians. This approach may be used as a template for the integration of other new independent health care facilities and programs into the existing health care system.

Client Experience with the Ontario Birth Center Demonstration Project

“…Although potential explanations for these positive transfer experiences cannot be concluded from the work we report here, they may be attributable to factors such as health care provider communication, 35,43 the ongoing presence of the midwife through the transfer experience, 35,42 and the manner in which the woman's care was handed over from one professional to another 42 . Previous work by our team demonstrated that health care providers generally described a positive and seamless system for transferring women between birth centers and hospitals 19 . Our findings from this current survey are in alignment with our previous findings from health care providers, suggesting that birth center–hospital transfers are generally working well, but further in‐depth qualitative work is required to better understand specific factors that influence women's transfer experiences in our setting.…”

“…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 …”

“…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 .…”

Qualitative evaluation of an innovative midwifery continuity scheme: Lessons from using a quality care framework

“…Transfer to a tertiary unit can be stressful, including women feeling they have “lost their dream” 13 and community‐based midwives feeling under‐supported by unit staff 14 . Such problems can be offset by proactive planning of transfer protocols by all relevant personnel 15 . In Angus, where the overseeing obstetrician strongly supports the scheme, a transfer protocol was included from the outset.…”

“…14 Such problems can be offset by proactive planning of transfer protocols by all relevant personnel. 15 In Angus, where the overseeing obstetrician strongly supports the scheme, a transfer protocol was included from the outset. The total transfer rate was 22.7% (or 15.3% when excluding women who were ineligible, but who nevertheless requested a home birth (see accompanying paper, this volume).…”