Evaluation of the Midwifery Pilot Projects in Quebec: An Overview

By Blais, Regis; Joubert, Pierre | Canadian Journal of Public Health, January/February 2000 | Go to article overview
Save to active project

Evaluation of the Midwifery Pilot Projects in Quebec: An Overview

Blais, Regis, Joubert, Pierre, Canadian Journal of Public Health


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.


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.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Cite this article

Cited article

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

Evaluation of the Midwifery Pilot Projects in Quebec: An Overview


Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?