bluuebunny/crossref_metadata_2025 huggingface dataset:
A Survey of Umbilical Cord Clamping Practices and Attitudes of Canadian Maternity Care Providers
Authors: Stoll Kathrin , Hutton Eileen
Published: July 2024

Despite mounting evidence of the health benefits of delayed cord clamping of term and preterm neonates, Canadian practice guidelines about the optimal timing of cord clamping have not been developed. At the time the study was conducted, the Society of Obstetricians & Gynecologists of Canada (SOGC) recommended early clamping as part of active management, while findings from several randomized controlled trials pointed at reported benefits of delayed cord clamping. It is unclear how Canadian maternity care providers were interpreting the evidence around umbilical cord clamping and what they do in clinical practice.
A link to an online survey was distributed to members of the Canadian Association of Midwives (CAM) and the SOGC to assess maternity care providers’ umbilical cord clamping practices and attitudes. Respondents were asked to answer questions pertaining to the timing of cord clamping, reasons for cord clamping practices and perceived benefits and risks associated with delayed cord clamping (> 60 seconds) for 1) term and 2) preterm infants (< 37 weeks).
A total of 353 respondents met eligibility criteria (i.e. they provided intrapartum care at the time of data collection). The majority of obstetricians (77.9%) reported clamping the cord of term infants immediately (< 30 seconds), compared to 60.0% of family physicians and 9.8% of midwives; 6.5% of obstetricians, 9.1% of family physicians and 65.7% of midwives reported delaying cord clamping by two minutes or more. Midwives were more likely than physicians to make a conscious decision about the timing of cord clamping. Care providers reported higher rates of immediate cord clamping with preterm infants, compared to term infants, with 85% of physicians and 39% of midwives clamping the cord of preterm neonates within 30 seconds. The most common reason for clamping the cord of a term neonate immediately was the infants’ need for resuscitation or other medical interventions (79%). Personal routine was the most frequently cited reason for clamping the cord of a preterm infant immediately (40%).
Findings from this survey highlight interprofessional variations in cord clamping practices. Clear practice guidelines around the optimal timing of cord clamping should be developed that take into considerations the health benefits of delaying cord clamping of term and preterm infants.
Towards DNA: Issues and Implications of Non-invasive Prenatal Genetic Testing
Authors: Besana Joanna
Published: July 2024

Non-invasive prenatal diagnosis (NIPD) will soon become the standard of care for prenatal genetic testing. NIPD uses DNA and has the potential to sequence the entire fetal genome and detect many diverse traits. Although both the public and midwives support the implementation of NIPD, concerns arise owing to the lack of agreement about what constitutes severe disabling traits. Further, there is limited understanding of the implications of such testing at both the individual and population levels. Midwives and other maternity care providers need to be better educated on all aspects of prenatal genetic testing - the limitations and implications of NIPD, as well as disability traits and living with them - in order to help their clients make truly informed choices.
Assessment of the Midwifery Education Program at the University of British Columbia – A Survey of Graduates and Midwife Mentors
Authors: Ellis Cathryn
Published: July 2024

The Midwifery Program at the University of British Columbia is the only academic centre for midwifery education in British Columbia. The program consists of arts and science courses, midwifery theoretical and clinical courses, problem-based learning tutorials, laboratory simulations, clinical experiences in community midwifery, and a semester of interprofessional placements in a local or global setting. As university based midwifery education is new to British Columbia, critical evaluation of the curriculum is essential. Between 2005 and 2010, we examined the curriculum annually from the perspective of new graduates (n=34) and their mentors (n=21) to inform curriculum renewal and development.
Overall graduates felt well prepared for clinical practice after graduating, and highly valued their clinical placements. Both graduates and midwife mentors reported competence with most clinical skills, and senior midwives noted the graduates’ fluency with both the hospital and home setting. Need for improvement was noted with respect to suturing and venipuncture. There were some discrepancies in the assessment of competencies. While all graduates felt well or adequately prepared to recognize and manage when a normal birth changes to abnormal, not all mentor midwives agreed. Conversely, midwife mentors felt that graduates were prepared in the area of client communication and counseling, yet graduates felt less confident in this area.
Over the years, the Midwifery Education curriculum has evolved to address feedback received via the yearly curriculum evaluation. The academic calendar has been modified to allow students and faculty more time for preparation, integration and reflection during the introductory year, to facilitate the consolidation phase in the core clinical courses, and to facilitate senior research projects. Courses on counseling, pharmacology for midwives, lactation consultation, global maternity care, and anatomy labs have been added to the curriculum. The program continues its effort to enhance theoretical and clinical teaching by offering regular preceptor workshops.
The Birth Shell for the Second Stage of Labour: A Modern Tool to Support Physiological Birth
Authors: De Jonge Ank , Kweekel Liselotte , Oudshoorn Tine , Keijzer-Landkroon Gré
Published: July 2024

Article.
Toward Equity in Access to Midwifery: A Scan of Five Canadian Provinces
Authors: Hanson Laurel , Mpofu Deborah (Debbie) , Hopkins Laura
Published: July 2024

This research project was created to support equitable access to midwifery care for the diverse populations of Saskatchewan women. Given the ongoing implementation and expansion of midwifery across diverse mixes of rural, urban, and aboriginal communities in the health regions of the province, we asked: How can midwifery care be implemented in an equitable and accessible way in Saskatchewan? The first phase of this research explored experiences with midwifery implementation around issues of accessibility through an environmental scan of five Canadian provinces (British Columbia, Manitoba, Ontario, Northwest Territories, and Nova Scotia). By analyzing policy and regulatory documents together with primary data generated through key informant interviews, we discovered an interesting compendium of provincial activities and policies in support of equity to access midwifery. We also identified several important areas in need of strengthening. In this article, we present a brief description of the best practices identified by each province, followed by an exploratory analysis of key thematic issues that are significant in creating equitable access to the full scope of midwifery care. These included funding models, interprofessional relationships, choice of birthplace and second attendants, risk designation, geographic dispersal, community integration, and midwifery human resources.
Cranberries and the Prevention and Treatment of Urinary Tract Infections
Authors: Beites Crestina L.
Published: July 2024

Clinical Question: Can urinary tract infections be treated

effectively with cranberry juice?
The Experiences of Pregnant Women Accessing Food in Remote Aboriginal Communities on Haida Gwaii
Authors: Greenwood Shannon , Kornelsen Jude
Published: July 2024

Context: Despite strong evidence supporting the importance of good nutrition in pregnancy for optimal perinatal outcomes, little research exists regarding the experiences of women’s access to food in pregnancy. This is particularly true of research on remote Aboriginal women, who may be constrained by local availability and costs of local food.
Methods: This research was carried out in a case study design and in a semi- structured qualitative interview format. Twelve women in the postpartum period on Haida Gwaii, British Columbia, were interviewed. Ethics approval was granted. Results were extracted, using a thematic analysis based on nine research questions.
Results: Three main themes emerged through the interviews with the participants: (1) access to traditional foods, (2) enablers to access, and (3) financial limitations.Conclusion: Aboriginal women in remote communities experience challenges accessing food during pregnancy. However, the integration of traditional foods into their diet was viewed as a strong contributor to improving nutrition in pregnancy. For participants in this study, accessing traditional foods embodied cultural values, provided opportunities for autonomy, and directly contributed to the health and well-being of pregnant mothers.

This article has been peer-reviewed.
Pratique sage-femme et gestion active du 3e stade: le temps d’une mise au point, de critiques et de commentaires
Authors: Lemay Céline
Published: July 2024

Commentaire.
Perinatal Outcomes for Four Toronto Midwifery Practices: Exploring Best Practices for Normal Birth
Authors: Van Wagner Vicki , Sharpe Mary , Rogers Judy , Brandeis Elizabeth , Levy Andrea , Sarkar Tia , Lynch Bridget , Dennis Kristen , Klein Leah , Robertson Jenna
Published: July 2024

This study explores outcomes from four Toronto midwifery practices from 2003 to 2007, using data from the Midwifery Outcomes Database to look at similarities and differences between the practices and with provincial averages. The goals of our project included establishing a university/community partnership with the participating practices, which included Ryerson and McMaster University faculty members; improving capacity among midwives with using a provincial database; and producing a comprehensive perinatal outcomes report for midwifery practices that could be used for internal review and for presentation at interprofessional forums such as hospital rounds and interprofessional conferences.
A comparative analysis between the practices and with the provincial midwifery data showed several trends, including an increased incidence of late maternal age, low rates of intervention, and high rates of home birth. Our research raises questions about scope of practice and best practices for supporting normal birth.

This article has been peer reviewed.
Vaginal Birth After Cesarean Section: Ethical Considerations for Midwives
Authors: Handa Manavi , Robertson Andrea
Published: July 2024

Vaginal birth after cesarean section (VBAC) and decisions regarding the safest mode and place of delivery can be contentious in contemporary obstetrics. The choice of birthplace adds additional layers to ethical concerns, particularly for midwives, who are often the only care providers attending birth outside the hospital setting. Current guidelines and evidence, drawing largely on obstetrical literature and the hospital environment, recommend hospital birth for anyone with a prior cesarean section. However, despite guidelines and care provider recommendations, a small proportion of women will continue to request midwife-attended homebirth. Ethical debates about VBAC have largely been inattentive to the desires of these women and the unique situation of midwives who may be presented with such requests. We will explore the ethical nuances of choice of birthplace for women planning a vaginal homebirth after cesarean section (HBAC). Analysis suggests that there may be implications to denying choice and some burden on midwives to continue to provide care for women planning HBAC, even when homebirth may not be considered the safest option.
Evening Primrose Oil for Cervical Ripening
Authors: Beites Crestina L. , Morgan Lisa
Published: July 2024

Research.
Toward Equity in Access to Midwifery in Saskatchewan: Key Informants’ Perspectives
Authors: Hanson Lori , McRae Daphne
Published: July 2024

In this article, we report on the second phase of our exploratory research into issues related to equity in access to midwifery in Saskatchewan. This phase of the research project aimed to explore equity in access to midwifery as understood and experienced by key stakeholders involved in the early stages of midwifery implementation in Saskatchewan. A total of 19 interviews were conducted with participants from Saskatchewan Health, the Midwifery Transitional Council, and Saskatoon’s Regional Midwifery Operations Committee, as well as practitioners, primary health care managers, directors from select regional health authorities, and Saskatchewan midwives. Additionally, all available midwifery policy documents and relevant Primary Health Care and Health Human Resource documents complemented the qualitative analysis.
Initial thematic analysis led to five policy recommendations: (1) develop a provincial definition of “priority population” for midwifery clients, (2) establish a midwifery health human resource plan, (3) identify provincial midwifery research priorities, (4) facilitate growth in interprofessional relationships, and (5) develop a provincial “road map” for implementation. A secondary analysis of participants’ responses revealed concern over the poor public education about midwifery services and lack of provincial government prioritization, as well as varied perceptions of the concept of “equity.”
We conclude that although general commitments to equity in midwifery service and access are enshrined in Saskatchewan’s health care policies and midwifery regulations, insider perspectives suggest that significant yet modifiable barriers to equity in access to care currently exist.

This article has been peer reviewed
Caring for Women with Newborn Custodial Losses: A Literature Review
Authors: Robertson Andrea , Kinsella Elizabeth Anne
Published: July 2024

Custodial loss at birth, for child protection purposes, is an acutely marginalized birth experience. Literature review demonstrates a significant need for further research, especially in regard to maternal perspectives and needs. Although direct maternal voices are overwhelming absent in the current literature, critical findings include that: 1) neglected grief is persistent and detrimental; 2) blame and stigma focused on the individual obscures complex social adversity (often inextricable from trauma), and 3) social and systemic factors disadvantage marginalized women in gendered ways. Canadian midwives are in an important position to explore care possibilities in the context of custodial loss and to engage in research which prioritizes the participation of those directly affected. \
La perte de la garde de l’enfant à la naissance, pour des motifs de protection de l’enfance, constitue une expérience d’accouchement gravement marginalisée. La revue de la littérature démontre la grande nécessité de procéder à de plus amples recherches, particulièrement en ce qui a trait aux points de vue et aux besoins de ces mères. Bien que la littérature actuelle soit essentiellement exempte de comptes-rendus issus directement des mères, on compte ce qui suit parmi les constatations cruciales qui en sont tirées : 1) le chagrin négligé persiste et exerce des effets préjudiciables; 2) le blâme et la stigmatisation axés sur la personne masque une adversité sociale complexe (souvent inextricablement liée au traumatisme); de plus, des facteurs sociaux et systémiques désavantagent les femmes marginalisées de façon sexospécifique. Les sages- femmes canadiennes se trouvent dans une position importante leur permettant d’explorer les possibilités de soins, dans le contexte de la perte de la garde d’un enfant, et de prendre part aux efforts de recherche qui accordent la priorité à la participation des personnes directement affectées.
Homebirth and the National Health Service in Italy. A qualitative study in the Emilia- Romagna Region
Authors: Quattrocchi Patrizia
Published: July 2024

Introduction: Medicalization of birth has increased all over the world in the past decades. The Italian caesarean birth rate (38%) is among the highest in the world. Could be birth at home as a public model of care a superior alternative to current practices? This paper focuses on the experience of the Emilia-Romagna region, where the National Health Service (NHS) has carried out a home birth service for more than 13 years. The aim is to discuss the strengths and weaknesses of homebirth as a public health model compared to homebirth within the private practice system.
Methods: Qualitative data were collected between 2010 and 2013, as part of a wider anthropological research project on out-of-hospital birth in Italy and Spain. Seventy participants were interviewed in total. In Emilia-Romagna, in- depth interviews were conducted with 21 participants; these included midwives, women, doctors and health managers. Focus groups, a field diary and participant observation were also used for data collection. Data were analyzed using ethnographic method and content analysis.
Results: Main findings suggest that the added value provided by the NHS home birth service in the Emilia-Romagna region (home births attended by community- based or hospital-based midwives) compared to the private care model encompass increasing of the social legitimacy of homebirth, the transfer of best practices from homebirth to hospital birth, increasing the continuity of care when the woman is referred to the hospital, increasing the continuity of training and the autonomy of midwives in caring for normal births in the hospital and providing free services. Homebirth managed by the NHS contributes to the promotion of a physiological model of care also in the hospital.
Facilitating the Implementation of Midwifery Services: The Case of Montérégie, Quebec
Authors: Clavel Nathalie , Paquet Caroline , Blais Régis
Published: July 2024

Objectives: This study analyzed midwifery services implementation in one region (Montérégie) of Quebec. The objectives were to determine whether services were implemented as planned and to identify factors that facilitated or impeded implementation. The aspects studied included organizational components; types of midwifery services provided; levels of interprofessional collaboration among midwives, physicians, nurses, and community organizations; and training activities offered to perinatal care providers and students.
Methods: This is a qualitative case study of one implementation experience and is based on three data sources: individual interviews and focus groups; policy and administrative documents related to the implementation; and a database compiled by the midwives on services provided. Data were collected and analyzed between July 2012 and March 2013.
Results: The implementation of midwifery services in Montérégie was successful and largely accomplished as planned. Its success was due to the alignment of two categories of favourable conditions. The first category consisted of appropriate policies and regulations, demand from service users, and support from front-line professionals. The second category concerned the implementation process and governance and included effective governance structures and mechanisms, dedicated resources, and leadership from champions.
Conclusion: The lessons from this study can be usefully applied to the introduction of midwifery services in jurisdictions where they are not currently present. They may also inform the implementation of other publicly funded health services or professionals in other jurisdictions.

This article has been peer reviewed.
Deconstructing Dissonance: Ontario Midwifery Clients Speak about Their Experiences of Testing Group B Streptococcus–Positive
Authors: Sharpe Mary , Dennis Kristen , Cates Elizabeth C. , Kehler Sophia , McGrath Kory
Published: July 2024

Group B streptococcus (GBS) is a bacterium commonly found in the vaginal flora and is usually of no consequence to women. However, vertical transmission of GBS to the baby during pregnancy and/or birth can lead to GBS-associated disease, a leading cause of neonatal morbidity and mortality in Canada and throughout the world. Screening for GBS at 35–37 weeks’ gestation and administration of intrapartum antibiotic prophylaxis for colonized women has become standard practice; however, there is little research surrounding clients’ experiences, knowledge, and perceptions of both the test and of testing positive for the bacteria. This phenomenological study used semi-structured interviews guided by open-ended questions to explore the experiences of six midwifery clients in southern Ontario who tested GBS-positive in 2009. Transcribed interviews were analyzed using grounded theory to identify key themes. The diagnosis sharply affected women’s experiences during pregnancy and labour and often led to dissonance for them regarding questions of risk, health, the concept of normal, the midwifery model, their birth plans, and the competence of their midwife. The themes are discussed in terms of their relevance to midwifery practice.

This article has been peer reviewed.
Ontario Midwives’ Attitudes About Abortion and Abortion Provision
Authors: Handa Manavi , Rosenberg Simone
Published: July 2024

Objective: In Ontario and across Canada, midwives do not provide pregnancy termination but provide referrals and support for clients. This differs from a number of international jurisdictions where abortion has been added to the midwifery scope of practice, resulting in safe outcomes for women and improved access to services. This study sought to survey Ontario midwives’ general attitudes towards abortion and willingness to incorporate abortion into the midwifery scope of practice. Ethics approval for the study was obtained from the Ryerson University Research Ethics Board.
Methods: An Internet-based cross-sectional survey was sent to all registered midwives in Ontario via the Association of Ontario Midwives. The survey consisted of seven sections, with a total of 43 Likert scale questions, 17 general questions, and space for open-ended comments at the end of each section. Comments were coded and analyzed for common themes.
Results: The survey was distributed to 523 midwives, all of the midwives registered in Ontario at the time of the study (2011). A total of 359 midwives participated, representing a response rate of 68% of all registered midwives in Ontario. The majority of respondents identified themselves as pro-choice; however, there were “limits to choice” expressed by many participants. Abortion was considered less acceptable at later gestations or for specific reasons such as gender selection or minor fetal anomalies. Study participants were divided over whether abortion should be added to midwifery scope of practice. Comfort with providing abortion services decreased as procedures were perceived to be more invasive or as requiring more medical expertise. The addition of misoprostol to Ontario midwives’ pharmacopoeia for early medical terminations was the most favoured expansion for midwifery scope of practice. Respondents were less willing to add surgical techniques to midwifery scope of practice. Midwives identified the current models of compensation and practice in Ontario, issues related to hospital integration, and opposition from clients as significant barriers to the provision of abortion services. Limited education about abortion during midwifery training and the desire for more learning opportunities were additional themes that emerged in this study.
Conclusion: This is the first study in Canada about midwives’ attitudes towards abortion and the inclusion of abortion within midwifery scope of practice. Further research in other Canadian jurisdictions would be useful to examine systemic issues, barriers, and attitudes at a national level. For abortion to be included within the scope of practice of Ontario midwives, issues related to the current model of care, compensation, and supplemental education would need to be addressed.

This article has been peer reviewed.
The Influence of Socio- economic Status on Adverse Birth Outcomes
Authors: Campbell Emily E. , Seabrook Jamie A.
Published: July 2024

Adverse birth outcomes are associated with infant morbidity and mortality and with an increased likelihood of type 2 diabetes, hypertension, and cardiovascular disease in adulthood. Socio- economic status (SES) is one of the most reliable predictors of health disparities, and although the association between SES and birth outcomes has been studied previously, this is, to our knowledge, the first review that encompasses several dimensions of SES and their influence on birth outcomes in a single article. Our review indicates that education, income, neighbourhood SES, and occupation all play a role at influencing birth outcomes. We contend that, because lifestyle approaches to reducing health disparities (e.g., better diet, more exercise) are in turn related to SES, public discourse and policy interventions would be better suited to focusing attention on more fundamental causes of adverse birth outcomes—particularly low SES— if we are to see major improvements in the health of our citizens.

This article has been peer reviewed.
The Impact of the Advances in Labour and Risk Management (ALARM) Course on Learners’ Perceptions of their Own and Others’ Professions
Authors: Murray Davis Beth , McConnell Meghan , Malott Anne , Mueller Valerie , Shaw Elizabeth , Solomon Patricia
Published: July 2024

Background: Simulation-based training in emergencies is beneficial
for all professionals who work in obstetrics. However, managing obstetric emergencies requires both technical and non-technical skills such as teamwork. Interprofessional education (IPE) offers an effective strategy for learning competencies in collaboration and teamwork. The Advances in Labour and Risk Management (ALARM) course offers a platform for simulated training in obstetric emergencies and has been offered for learners in maternity care at our university for the past five years.
Objective: The aim of the project was to explore the impact of interprofessional learning during the ALARM course on the attitudes and perceptions of learners in maternity care.
Methods: A two-part questionnaire was administered to midwifery students and to family medicine and obstetric residents before and after the ALARM course. The questionnaire incorporated the Interdisciplinary Educational Perception Scale (IEPS) and open-ended qualitative responses.
Results: Despite openness to and awareness of the importance of collaboration for patient care demonstrated in the qualitative analysis, there was a statistically significant difference between learners’ pre- and post-ALARM IEPS scores, indicating more negative perceptions of IPE following the intervention.
Conclusion: Learners in maternity care are aware of the need for collaboration in practice. More explicit attention to teamwork and collaboration as a component of the ALARM course would promote development of both technical skills and nontechnical collaborative competencies.

This article has been peer reviewed.
Understanding Placentophagy: An Informed Response Discussion
Authors: Larsen Leslee
Published: July 2024

Article.
The Birth Centre Midwifery Group in Winnipeg, Manitoba
Authors: Sharpe Mary
Published: July 2024

Practice profile.
Understanding the Childbirth Experiences of Childhood Sexual Abuse Survivors: A Phenomenological Study
Authors: Mathewson Caitlin , Espin Dr. Sherry , Van Lieshout Ryan , Dore Sharon , McNiven Patricia
Published: July 2024

This study describes the childbirth experiences of survivors of childhood sexual abuse, using an interpretative phenomenological approach. Data collection involved in-depth, semistructured interviews of four women who gave birth to a baby within the last 5 years. Using Interpretative Phenomenological Analysis, three superordinate themes emerged: control, anxiety, and detachment. This contributes to the current body of research by extending knowledge on what it means to experience childbirth for survivors of childhood sexual abuse, told by the woman herself. These findings are especially important in understanding what is required in providing safe, sensitive care for all childbearing women and has important implications for practice, education, and further research.

This article has been peer reviewed.
Experiences, Opinions, and Use of Complementary and Alternative Medicine Among Alberta Midwives
Authors: Oguaju Chinelo , Dewey Deborah , Wolbring Gregor , Becker Gisela , Page Stacey
Published: July 2024

Background: Complementary and alternative medicines (CAMs) are widely used by individuals in many parts of the world to treat different ailments and maintain good health. Midwives are maternity care providers who may recommend or provide CAMs to assist clients with their pregnancies and childbirth and the early neonatal health of infants. There are currently no provincial data on the recommendation and use of CAMs by Alberta midwives.
Objectives: To describe the use, experiences, and opinions of Alberta midwives about CAMs, as well as their self-reported educational needs relating to CAM.
Method: A descriptive cross-sectional survey was distributed to all midwives registered with the Alberta Association of Midwives.
Result: The response rate to the survey was 23.7% and the completion rate was 82.7%. About 90% of the participating midwives recommended CAM, and 45.8% provided CAM very often to their clients. Client preferences and scientific evidence of efficacy were the most commonly stated reasons for recommending CAM. More than two-thirds (70.8%) of respondents believed that they lacked adequate CAM education.
Conclusion: CAM was frequently recommended by the midwives who participated in this study. However, the majority of the participants indicated that they lack adequate knowledge and education in regard to CAM. Consequently, providing more CAM education opportunities for midwives may be justified.

This article has been peer reviewed.
Disparities in Maternal and Newborn Health Across Populations in Canada
Authors: Scott Naomi
Published: July 2024

Midwives are in a good position to understand the socio- economic, political, and cultural contexts of vulnerable populations, and could help with obstetrical data collection that would inform policies that affect poor, black, Aboriginal, and immigrant women in Canada.
Student article.
Midwives and Medwives: An Analysis of Technology Use among Canadian Midwives
Authors: Zenith Kathleen E. , Wilson Kathi
Published: July 2024

The dichotomy of a midwife and 'medwife' underlies a deeper issue regarding the professional identity of midwifery in relation to legislation, integration, and the increasing expansion of clinical scope, in contrast to the “natural birth” movement.
A Qualitative Exploration of Past Family Planning Counselling of Adolescent and Young Mothers
Authors: Gerster Katherine , Murray-Davis Beth , Dason Ebernella Shirin , Costescu Dustin
Published: July 2024

Objective: This study explores the family planning counselling that adolescents receive during pregnancy care, with the aim of identifying those factors that make counselling effective or ineffective.
Methods: The study population consisted of ten adolescents who had recently given birth and ten health care providers. Adolescents were recruited using posters; providers, by email. Individual semistructured interviews were conducted and analyzed in keeping with grounded theory. Analysis consisted of open coding (identification of initial concepts), axial coding (drawing connections between repetitive and similar concepts), and selective coding (clustering of categories to identify themes).
Results: The adolescent participants desired detailed information about pregnancy and motherhood, were challenged by the disruptive effects of pregnancy, and were strongly reliant on nonmedical support people. Our participants described that the adolescent-provider relationship was strengthened when providers sought to empower adolescents and to provide a balance of support and independence. Judgment and bias interfered with relationship building. Postpartum continuity with the pregnancy care provider and a positive relationship with the family physician were both highly desirable yet highly variable. In general, the adolescents found family planning counselling an awkward and intimate undertaking and preferred providers to slowly progress towards explicit counselling. The adolescents who opted not to initiate postpartum contraception still found the counselling process informative and beneficial.
Conclusion: Effective family planning counselling is not information driven but rather gradual, individualized, and context focused.

This article has been peer reviewed.
The Safety and Feasibility of Contraception Care by Midwives and Other Nonphysician Providers: A Scoping Review of Randomized Control Trials
Authors: Currie Beth , Marquez Olivia , Darling Elizabeth
Published: July 2024

Background: Although midwives in most Canadian provinces and other high-income countries have contraceptive prescribing ability, it is not within the Ontario midwifery scope of practice.Aim: To outline the contraceptive-related scope of practice of midwives in Canada and other high-income countries and to review the outcomes of contraceptive provision by physician versus nonphysician providers.Methods: We conducted an environmental scan through a search of grey literature to summarize contraception-related scopes of practice of midwives in provinces across Canada and in other high-income countries. We then conducted a scoping review of randomized controlled trials (RCTs) that examined the outcomes of physicians compared with nonphysician providers for the provision of contraception care, and summarized that evidence.Findings: Our environmental scan revealed that Quebec and Ontario are the only provinces in Canada in which midwives cannot prescribe contraception. In the following industrialized countries, midwives with education similar to that of Ontario midwives are able to prescribe contraception: New Zealand, Australia, United States, Sweden, Norway, Netherlands, Finland, and France. Our review of RCTs indicates that for most measures of competency, the outcomes of physician and nonphysical providers are similar when providing contraception care.
This article has been peer reviewed.
Current Alcohol Screening and Brief Intervention Practices among Canadian Midwives
Authors: Schmidt Rose A. , Kaminsky Kyla , Green Courtney R. , Cook Jocelynn L.
Published: July 2024

Alcohol use during pregnancy is associated with multiple adverse health outcomes for the woman and fetus, including stillbirth, miscarriage, low birth weight, and risk of fetal alcohol spectrum disorder (FASD). Midwives are uniquely situated to routinely engage in conversations about alcohol use with women that are strength based, health promoting, and focused on empowerment. This report is a secondary analysis of the midwifery responses (n = 196) from a larger data set of health care providers collected by the Society of Obstetricians and Gynaecologists of Canada (SOGC) in an online survey in October and November 2017. The aim of the survey was to identify current knowledge, attitudes, practices, and beliefs among Canadian health care providers on screening, brief intervention, and referral (SBIR) for women’s alcohol use. Most midwives (97%) ask women about alcohol use during pregnancy; however, only about half practice brief intervention (57%). Perceived confidence in conducting brief intervention was positively associated with its practice (t [193] = 5.31, p < .0001). Improving skills and confidence to provide brief support about alcohol use during pregnancy using evidence-informed approaches will strengthen this practice in Canada.

This article has been peer reviewed.
Maternity Service Delivery in Manitoba, Canada: A Retrospective Analysis of Three Maternity Care Provider Types
Authors: Thiessen Kellie , Haworth-Brockman Margaret , Nickel Nathan , Morris Margaret , Robinson Kristine , Bourgeault Ivy , Derksen Shelley
Published: July 2024

Background: Alleviating shortages in health workforce and delivery of efficient maternity care models are unresolved policy issues in Canada. In the province of Manitoba, obstetricians do the majority of maternity care, family practice physicians take care of low-risk women, and midwives continue to deliver care to about 5% of the low-risk pregnant women. The purpose of this study was to describe how maternity care is provided in Manitoba, based on a revised definition of Most Responsible Provider, and to compare maternal and perinatal outcomes by provider type.
Methods: Administrative data were used from the Manitoba Centre for Health Policy (MCHP) to select women who had a low-risk pregnancy. Descriptive statistics and logistic regression were used to examine differences in types of intervention, mode of delivery, and outcomes by provider type among low-risk women. Logistic regression models controlled for socio-demographic and birth-related covariates.
Results: From 2004/05 to 2012/13, there were a total of 132,918 births in Manitoba. Of those births, 47,083 were identified as high risk (35%), and 85,835 (65%) were identified as low risk. Key findings demonstrate midwifery care compared to obstetrical care was associated with lower odds of interventions such as cesarean section (0.47 [0.40–0.54]), induction (0.42 [0.39–0.49]), and episiotomy (0.48 [0.41–0.55]), but higher odds of postpartum hemorrhage (1.35 [1.18–1.55]), and shorter lengths of stay in hospital (-0.58 [-0.61-0.56]). Family practice physicians also had decreased odds of assisted vaginal delivery (0.82 [0.76–0.89]), epidural use (0.59 [0.57–0.62]) and third- and fourth-degree tears (0.82 [0.73–0.92]), but higher odds of augmentation (1.06 [1.01–1.11]). Results reported for midwives and family practice are compared to obstetricians.
Conclusions: A health workforce strategy that optimizes how to address the maternity care needs in the province of Manitoba is needed. There is suboptimal integration of midwifery services that could meet the low-risk population needs. Human health workforce development requires a good understanding of each provider’s role, opportunities for collaboration and integration to be strengthened, and the potential to optimize the outcomes for mothers and infants.

This article has been peer reviewed.
Making Midwifery Services Accessible to People of Low SES: A Qualitative Descriptive Study of the Barriers Faced by Midwives in Ontario
Authors: Darling Elizabeth K. , MacDonald Tonya , Nussey Lisa , Murray-Davis Beth , Vanstone Meredith
Published: July 2024

Midwifery care is associated with health benefits for disadvantaged groups but continues to be accessed less frequently in Ontario by people who are of lower socio-economic status (SES). We conducted a qualitative descriptive study investigating the work midwives do to make midwifery care accessible to people of low SES and explored the barriers they encounter in doing this work. We interviewed 13 Ontario midwives who serve people of low SES in a wide range of clinical settings. Participants faced multiple challenges in their work to make midwifery care more accessible. They described barriers that they had encountered which pertained to the nature of the work itself, to professional and organizational factors, and to systemic factors. Midwives engaged in this work are deeply committed to it and take on extra unpaid work. The barriers they face threaten the sustainability of their work, and as a result, many participants identified a high risk of burnout. Our findings provide new insight into ways in which gaps in the curriculum of undergraduate midwifery education, lack of opportunities for mentorship, and debate within the midwifery profession about who is suitable for midwifery care serve as barriers to midwives taking on a greater role in providing care to people of low SES and particularly to those who struggle to access primary maternity care services. Systemic changes are needed to overcome these barriers and to expand the work of making midwifery care more accessible while ensuring its sustainability.

This article has been peer reviewed.
THE EVOLUTION OF THE SOCIAL SCIENCE OF MIDWIFERY AND ITS CANADIAN CONTRIBUTIONS
Authors: Bourgeault Ivy Lynn
Published: July 2024

Commentary.
MEASURING BIRTH OUTCOMES: VALIDATING THE PERINATAL OUTCOME INDEX
Authors: McNiven Patricia, , Kaufman Karyn , Enkin Murray
Published: July 2024

We undertook a study to assess the reliability and validity of a new measure of low risk maternity care. A Perinatal Outcome Index (POI), which combines intrapartum process of care and clinical outcome items into a summary index score, was originally developed and evaluated in the Netherlands. It was designed to measure the extent to which a labour and birth are "optimal", that is, one with minimal intervention resulting in a healthy mother and a healthy baby. We modified the Dutch index to make it applicable to a Canadian setting. A panel of experts who were not connected with the study reviewed the modified version for applicability, feasibility of obtaining data easily, and content validity. Data were abstracted from the health records of 324 women in one hospital and two midwifery practices to obtain Perinatal Outcome Index scores and examine aspects of construct validity. We measured the inter-rater reliability of the research assistants who abstracted information. The panel achieved consensus on all items in the modified Perinatal Outcome Index to establish content (face) validity. Labour and birth data were readily obtained from health records with high inter-rater reliability (Kappa 0.78). In a linear regression model, birth at home, multiparity, and having a midwife or family physician as a care provider were significantly associated with higher scores (having a more optimal birth) and accounted for 37% of the score variance. The Perinatal Outcome Index has satisfied our expectations for content and construct validity. Research assistants found it easy to use and data items were readily available from women's health records. Inter-rater reliability was acceptable. We believe the modified index will be useful for comparative studies among women at low or average risk, and for quality assurance programs.
GALACTOSEMIA: A CASE STUDY
Authors: Hutton Eileen K. , Tudor Tory , Ejiwunmi Remi
Published: July 2024

Inborn errors of metabolism often manifest with varied clinical presentations in the neonatal period. Prevention of morbidity or mortality is frequently contingent on early diagnosis. Midwives have a role to play in recognizing symptoms that may be consistent with such a diagnosis. This paper describes the clinical findings in the case of a newborn in midwifery care who was diagnosed with galactosemia on day 10. This metabolic disorder is described and midwifery implications arising from this case are discussed.
Understanding the Limitations of Maternity Cost Studies: Why Context Matters
Authors: Thiessen Kellie , Witt Julia , Peden Alexander , Haworth- Brockman Margaret , Nickel Nathan , Morris Margaret , Robinson Kristine , Bourgeault Ivy , Derksen Shelley
Published: July 2024

Background: Limited, publicly available evidence exists to inform maternity care workforce planning in Manitoba as well as elsewhere in Canada. This manuscript offers a discussion about how context is critical when considering how cost, efficiency, and efficacy data are used.Methods: Our cost analysis of maternity care in Manitoba, Canada, focused exclusively on women with low- risk pregnancies from combined dates (2004/05 to 2008/09 and 2009/10 to 2012/13).
Results: Although our cost analysis found that maternity care provided by family physicians had the lowest overall expected cost, and that highest effectiveness, measured by avoided neonatal intensive care unit (NICU) admissions, midwives had the lowest hospital costs and similar cost-effectiveness to other provider types.
Interpretation: The context of how different maternity care professions are integrated into the system has a substantial impact on the assessment of overall cost. Caution must be used in interpreting these findings from significantly different models of care. The roles of providers are rarely articulated in cost study analyses to capture the breadth of services beyond “in-patient” costs.

This article has been peer reviewed.
Leave of Absence and Return to Work Among Canadian Midwives Who Experience Mental Health Issues: Pilot Study Findings
Authors: Atanackovic Jelena , Freeman Angela , Demers Chantal , Neiterman Elena , Benoit Cecilia , Thiessen Kellie , Bourgeault Ivy
Published: July 2024

Despite the salience of mental health issues in midwifery, we have a limited knowledge of the experiences of midwives who take a leave due to personal or family-related mental health challenges. Our paper draws on a pilot study that aimed to address this gap in the literature by exploring the factors fostering or impeding midwives’ decision to take a leave and to return back to work. In addition to a scoping review of the academic and grey literature conducted on these issues, we administered a pilot online survey completed by sixteen midwives and conducted interviews with seven midwives. Our findings show that challenging working conditions, common to midwifery, can pose mental health challenges impacting midwives’ working ability and leading to leaves of absence or attrition. We also found that certain demographic factors make midwives more likely to leave their work due to mental health challenges. Our findings suggest that specifically targeted programs and policies might be very helpful in facilitating midwives’ return to work.

This article has been peer reviewed.
CORE LINK: “COLLABORATIVE OBSTETRICAL RESOURCE” PROPOSAL FOR LOW RISK OBSTETRICAL SHARED CARE CLINICS
Authors: Murdoch Jennifer
Published: July 2024

As a growing number of women and their families seek low risk obstetrical care, the number of maternity care providers falls. For family physicians, this is due in large measure to an unsustainable model of practice that includes constraints on lifestyle, prohibitive malpractice insurance and unsatisfactory remuneration. Ontario, British Columbia, Manitoba, Quebec and Alberta have regulations in place for midwifery to address this growing problem. However, due to the limited scope of practice for midwives, the small number of practitioners, and the profession's attrition rate in general, there continues to be an enormous gap between the demand for access and the supply of low risk obstetrical care providers and services.i
It is proposed that CORe LINK, Collaborative Obstetrical Resource Link, will develop shared-care clinics across the country, called Maternity CORe sites. These clinics will work within an interdisciplinary model developed to harness the unique skills and expertise of all community based, primary care professionals who work with the low risk obstetrical population, while addressing the barriers and challenges that these practitioners face in doing their work.
CORe LINK is currently seeking approval in Ontario to pilot this project. A proposal for the CORe LINK project was submitted in November 2003 to the Primary Health Care Transition Fund.ii CORe LINK approval is pending to begin a fully integrated model of service delivery. As an interim approach, a two-phase process has been proposed that does not interfere with existing models of care. CORe LINK will utilize common clinical and evaluation tools to ensure that there will be a multi-centred approach to data collection and analysis across all Maternity CORe sites.
This article will discuss how the CORe LINK project can both entice new practitioners to practice family centred obstetrics and conserve and protect established professionals from leaving through the development of an interdisciplinary approach to practice, funded through an Alternative Payment Plan within a shared liability model.