Evaluation of the Midwifery Pilot Projects in Quebec: An Overview

Article excerpt

ABSTRACT

In 1990, the province of Quebec adopted a law authorizing the evaluation of the practice of midwifery through eight pilot projects. The projects, which took the form of birch centres outside hospitals, started operating in 1994. The objectives of the evaluation were 1) to compare midwives' services to current physician services with regard to maternal and neonatal mortality and morbidity, the use of obstetrical intervention> individualization and continuity of care as perceived by clients, and cost; and 2) to identify the professional and organizational factors associated with the integration of midwives into the health care system. A mixed evaluative design was used: a multiple case study with each pilot project representing a case and a cohort study where 1,000 women followed by midwives in the birth centres were matched with 1,000 women followed by physicians in the usual hospital-based services. Various quantitative and qualitative data collection instruments were used. Overall, many results were Favourable to midwifery practice, while some were Favourable to medical care. Following the evaluation, the Government of Quebec decided to legalize the practice of midwifery.

ABREGE

En 1990, le Quebec adoptait une loi autorisant, a titre experimental, la pratique des sages-femmes dans huit projects-pilotes. Les projects, qui ont pris la forme de maisons de naissance en dehors de hopitaux, ont ete mis en place a partir de 1994. Les objectifs de l'evaluation de l'experimentation etaient 1) de comparer les services des sages-femmes a ceux des medecins en ce qui a trait a la mortalite et la morbidite maternelle et neonatale, l'utilisation des interventions obstetricales, l'humanisation et la continuite des soins selon lex clientes et les couts; et 2) d'identifier les facteurs professionnels et organisationnels associes a I'integration des sages-femmes au systeme de sante. Un devis d'evaluation mixte a ete utilise: une etude de cas multiple ou chaque project-pilote est un cas et une etude de cohorte ou 1 000 clientes suivies par des sages-femmes dans les maisons de naissance ont ete jumelees a 1 000 clientes de medecins suivies en milieu hospitalier. Differents instruments de collecte de donnees qualitatifs et quantitatifs ont ete utilises. Dans l'ensemble, de nombreux resultats etaient favorables a la pratique des sages-femmes, alors que certains etaient favorables a celle des medecins. A la suite de l'evaluation, le gouvernement du Quebec a decide de legaliser la pratique sagefemme.

Canada is the last industrialized country to undertake the legal recognition of midwifery practice. There were midwives in the early days of the country, but the rarity of training programs and the progressive take-over of maternity care by physicians led to their near disappearance, except in the North.1 In the 1970s and 80s, however, women across Canada began requesting midwives' services, arguing that pregnancy and birth had become too medicalized. They also wanted to have more control over this important event in their lives. Some women chose to receive prenatal care from and give birth assisted by midwives outside the formal health care system.

In response to women's and midwives' demands for legal recognition, several provinces took legislative steps in the 1990s to regulate midwifery. To date, however, only Ontario, as of January 1994,2 and British Columbia, as of January 1998, have allowed midwives to fully practice their profession. The province of Quebec chose to evaluate midwifery for a few years before deciding whether or not to legalize it. In 1990, Quebec adopted Bill 4, a law authorizing the evaluation of the practice of midwifery through pilot projects.3 The stated goals of this law were twofold: 1) to determine the relevance of legalizing midwifery in Quebec and 2) if found relevant, to define the professional organization of midwifery and the mode of integration of midwives into the health care system. …