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Health Care Reform
1. What do Women Want?
2. Privatization and Women’s Health in
Canada: Tracking the Effects of Health Care Reform
Serving Diversity
3. Marginalized Voices from Vancouver’s
Downtown Eastside: Aboriginal Women Speak About Their Health Care Experiences
4. An Exploration of Women-Centred Care in
the Context of Cervical Cancer Screening in Ethnocultural Groups
Unpaid Caregiving
5. Caregivers’ Support Needs: Insights from
the Experiences of Women Providing Care in Rural Nova Scotia
6. Caregivers and Support Services: Becoming Empowered
Midwifery
7. Challenges of Integration: Perspectives on
the Regulation of Midwifery in British Columbia
8. Midwifery Care: Women’s Experiences, Hopes and Reflections
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Midwifery Care: Women’s Experiences, Hopes and Reflections
Lorna Breitkreuz, Cathy Ellis, Midwives Association of Saskatchewan, Meaghan Moon, Manitoba Traditional Midwives Collective, and Cindy Hanson, The International Midwifery Day Committee
The midwifery philosophy of care considers birth within the
social, biological and psychological context of women’s lives.
This holistic view translates into a model of practice that
places women at the centre of control of the birth
experience. Until recently, midwives practising in Manitoba
and Saskatchewan have, for the most part, been accountable
to the women they serve. However, with the move to
regulation and the recognition of midwifery as an
autonomous profession, changes in the delivery of
midwifery services are inevitable. The purposes of this
project were to document women’s experiences of midwifery
care, to determine if the kind of care women received from
their midwives was satisfactory, and to see if this care
corresponded with what midwives think women want.
Methods
We used a participatory approach to gather data from both
midwives and women who received care from midwives.
Using this approach, investigators were participants as well
as project researchers. The research team consisted of three
midwives, three consumer interviewers and one midwifery
consumer, most of whom belong to midwifery associations
and consumer groups. Researchers consulted members of
their respective groups in the development of the project. A
total of 16 women who had used midwifery services
participated in open-ended interviews about their
experiences with midwifery. Four midwives in Saskatchewan
and seven in Manitoba participated in focus groups in which
they discussed their beliefs regarding the care women were
looking for from midwives. Both the interviews and focus
groups were tape recorded and the tapes transcribed and
analysed for themes.
Findings From the Mothers
Dominant themes that emerged from the interviews with
the mothers fell broadly into three categories: the issues
associated with accessing a midwife, the quality of care and
quantity of the time that midwives spend with women,
which encompasses the personal care and support women
felt midwives gave them and their families and the style of
care or practice that midwives provided, and, thirdly,
recommendations for policy development on midwifery.
Access
Knowing where and how to find a midwife was a great
challenge for many women. Women spoke about a lack of
information to help them find a midwife; chance often
played a role in locating one. Rural women were particularly
disadvantaged in obtaining access to midwifery care. Cost
was also a factor in limiting women’s access to midwifery
services, although every women in this study found ways to
overcome financial obstacles.
Quality of Care and Quantity of Time
The length and frequency of midwifery visits surpassed the
expectations of study participants. The mothers reported
that the quantity of time midwives spent with them allowed
them to ask questions, explore a variety of aspects of birth,
and to develop a positive relationship with the midwife.
Personalized care and support included home visits, being
given sufficient resources to make informed choices, and
care that was consultative but not directive. These factors
contributed to women feeling empowered and personally
strengthened by their midwife-assisted birth. Women also
felt that their family as whole was supported by the midwife.
Midwifery care was described as holistic, unobtrusive, lowtech
and competent. The women were surprised at the level
of post-partum care and described midwives making meals,
giving sponge baths, taking laundry home, cleaning the
house and being available to talk during the post-partum
period. All of these elements of care fostered strong feelings
of trust and safety between the women and their midwives.
Findings from the Midwives
Each of the midwives’ focus groups identified five elements
they believe that women want from midwifery. In
Saskatchewan these were: cost of care, the midwife’s
experience and training, the midwife’s philosophy,
continuity of care by familiar caregivers (the same
midwife/partner attending the woman throughout
pregnancy, labour, delivery and postpartum, with emphasis
on labour and delivery), and competence (the belief that the
midwife could detect and deal with most problems).
Midwives in the Saskatchewan focus groups also thought
that women considering home births would be concerned
with the political aspects of midwifery.
Midwives in Manitoba thought that women wanted to
know about the midwife’s scope of practice, her philosophy,
and her background and training. They stated that women
wanted individualized care and a commitment to the
woman during the childbearing year. They believed that cost
of care was also of concern to most women.
Recommendations
The goal of this research project was to find out if midwifery
clients felt that their needs were being met by midwives.
Reflecting upon their experiences in answer to this question,
women recommended that there be:
- public funding of midwifery services,
- midwifery services in rural and northern communities, as
well as in urban centres,
- regulation of midwifery as an autonomous profession;
- workloads that permit time for quality care,
- midwifery practice available in a variety of settings,
including home, hospital and birth centres,
- continued personalized services in the home, and
- education campaigns demonstrating the value of
midwifery services targeted to medical personnel, health
administrators, and the public.
As midwifery is currently in the process of being regulated
in Saskatchewan and Manitoba, this project provided a
timely opportunity for midwifery clients to suggest policy
recommendations.
For a full copy of the report contact:
Prairie Women’s Health Centre of Excellence
Room 2C11A
The University of Winnipeg
515 Portage Avenue
Winnipeg, Manitoba, Canada R3B 2E9
Tel: (204) 786-9048 Fax: (204) 774-4134
Toll Free: 1-888-658-1112
E-mail: pwhce@uwinnipeg.ca
Web site: www.pwhce.ca
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