Childbirth: A Medical Problem or a Health Concern

Abstract

Throughout the literature varying opinions exist concerning the health outcomes, service utilization and patient satisfaction as they relate to maternal and infant care given by physicians versus midwifery care. This study looks at the following question; what differences are there in health outcomes, service utilization, and patient satisfaction, between women who are cared for by either physicians or midwives and vaginally deliver a singleton healthy baby in hospital? This study employs a secondary analysis of data from the TOMIS II study. The TOMIS II data was collected from 250 women in each of five hospital sites in Ontario in 2002. The analysis showed that, except for the breastfeeding, all of the measures of maternal and infant health outcome did not statistically differ between physician-care and midwifery care. With respect to service utilization, the results indicated that family physician visits, length of stay, and utilization of the Healthy babies, Healthy Children (HBHC) resulted in statistically significant lower service utilization by mothers in the midwifery group, while the other measures were found not to be different. Patient satisfaction measures revealed that women receiving midwifery services were much more satisfied with their care than were women receiving physician-based services. Five conclusions were drawn from this study; midwifery care is a viable option for maternity care in Ontario for low-risk birth mothers; the utilization of midwives reduces the total amount of services being used in the health care system; women are more satisfied with their care when they have midwives participating in all parts of their care; health policy in Ontario should focus its efforts to expand midwifery to make it a viable option for maternal and infant care to all healthy women; health care policy should support publicly funded midwifery in each of the jurisdictions in Canada, as a cost-effective approach to care with comparable outcomes.