Science & Technology, Canada (Commonwealth Union) – Midwifery is the practice of providing care and support to women during pregnancy, childbirth, and the postpartum period. The practice of midwifery has a long history and is practiced in many cultures around the world.
Recent research from the University of British Columbia (UBC) demonstrates that midwives in British Columbia (B.C.) have given safe primary care for pregnancies of all medical risk levels, contradicting a common perception that midwives manage low-risk pregnancies to a large extent.
The findings that appeared in the Canadian Medical Association Journal, evaluated a decade of births in the state between 2008 and 2018. Researchers contrasted birth outcomes for individuals with a midwife as their most responsible provider (MRP), with individuals who had care from a family physician or obstetrician.
The study shows that individuals with a midwife as their MRP had comparable or enhanced birth outcomes relative to family physician- or obstetrician-led care among medical risk levels. Midwifery clients had a lower likelihood to have preterm births and low-birth-weight babies when contrasted to physician-led care, and risks for infant deaths was comparable across MRPs.
“The study provides evidence that midwifery care in B.C. is a safe and effective option for childbearing people, regardless of medical risk,” explained Dr. Kathrin Stoll, a research associate in the UBC department of family practice. “As medical risk increases, midwives and family physicians collaborate with obstetrician specialists to ensure that birthing people are receiving safe and appropriate care that is right for them.”
Researchers indicate that their findings reflect on how midwives are merged into the B.C. health system.
“Midwives operate in two worlds: They are in the community working with people in their homes, but they are also integrated into the hospital system,” said Dr. Stoll. “When complications develop, midwives are a bridge to the specialist and hospital care that a person needs.”
Midwifery recipients further had consistently lesser caesarean delivery rates when contrasted to individuals with physician MRPs, although the rate of caesarean delivery was elevated as medical risks went up. Nearly 37% of births in B.C. were caesarean deliveries in 2019-2020, the most in Canada, according to researchers.
The recent findings indicate the way midwifery care in B.C. has progressed as it ended up as a regulated health profession since 1998.
The study indicates that the proportion of births that had a midwife MRP went up from 9.2% in 2008 to 19.8% in 2018. That proportion has continued to rise in more recent years, with midwives presently helping with almost a third of all births in B.C. which is the largest proportion in the country.
The researchers stated that the results were not surprising as medical risks has always been a key area of the profession.
“A large part of midwifery education is teaching students about medical complexities and how to triage clients in terms of their medical risk. It’s always been a part of midwifery training and the care midwives provide,” said Dr. Luba Butska, an assistant professor of teaching with the UBC midwifery program in the department of family practice.
In spite the elevations in midwifery care as the study period occurred, the country has some of the least rates of midwifery access worldwide along with elevated rates of caesarean delivery.
The researchers recommended that the elevation of the midwifery profession must be backed by policies and payment structures permitting the retention of midwives, together with health system integration and collaboration with physician colleagues.
“As the midwifery profession continues to grow in Canada, it holds potential for meeting national mandates to lower obstetric intervention rates and to increase access to midwifery care to under-served communities,” explained Dr. Butska who also indicated that it was the combination of positive outcomes and less intervention rates that make midwifery a good public health strategy.
