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Canadian Journal of Public Health

, Volume 91, Issue 1, pp I5–I11 | Cite as

Comparison of Midwifery Care to Medical Care in Hospitals in the Quebec Pilot Projects Study: Clinical Indicators

  • William FraserEmail author
  • Marie Hatem-Asmar
  • Isabelle Krauss
  • Françoise Maillard
  • Gérard Bréart
  • Régis Blais
  • Johanne Collin
  • André-Pierre Contandriopoulos
  • Maria De Koninck
  • Andrée Demers
  • Pierre Joubert
  • Deena White
  • Francine Desbiens
  • Claude Gagnon
  • Daniel Reinharz
Article
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Abstract

The purpose of this study was to compare indicators of process and outcome of midwifery services provided in the Quebec pilot projects to those associated with standard hospital-based medical services. Women receiving each type of care (961 per group) were matched on the basis of socio-demographic characteristics and level of obstetrical risk. We found midwifery care to be associated with less obstetrical intervention and a reduction in selected indicators of maternal morbidity (caesarean section and severe perineal injury). For neonatal outcome indicators, midwifery care was associated with a mixture of benefits and risks: fewer babies with preterm birth and low birthweight, but a trend toward a higher stillbirth ratio and more frequent requirement for neonatal resuscitation. The study design does not permit to conclude that the associations were causal in nature. However, the high stillbirth rate observed in the group of women who were selected for midwife care raises concerns both regarding the appropriateness of the screening procedures for admission to such care and regarding the quality of care itself.

Résumé

L’objectif de cette étude était de comparer la nature et les effets des services de sages-femmes offerts dans les maisons de naissance et mis en place dans le cadre de projets-pilotes au Québec, avec les services médicaux courants dispensés dans des hôpitaux. Au total, 1 922 femmes ont été jumelées (961 par groupe) sur la base de leurs caractéristiques sociodémographiques et de leur risque obstétrical. Les résultats montrent que la pratique des sages-femmes est associée à une utilisation moins fréquente des interventions obstétricales et une réduction de certains indicateurs de morbidité (césariennes et déchirures du périnée de 3e et 4e degré). Par contre les effets concernant la morbidité néonatale sont mitigés: moins de bébés prématurés ou de petit poids à la naissance, mais une tendance vers un ratio plus élevé de mortinatalité et un besoin plus fréquent de réanimation à la naissance. Le devis de l’étude ne permet pas de conclure à des associations de nature causale. Cependant, le taux élevé de mortinatalité observé chez les femmes choisies pour recevoir les soins de sages-femmes soulève des préoccupations concernant la pertinence des procédures de sélection pour l’admissibilité à ce type de soins et la qualité des soins eux-mêmes.

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Copyright information

© The Canadian Public Health Association 2000

Authors and Affiliations

  • William Fraser
    • 1
    Email author
  • Marie Hatem-Asmar
    • 2
  • Isabelle Krauss
    • 2
  • Françoise Maillard
    • 3
  • Gérard Bréart
    • 3
  • Régis Blais
    • 4
  • Johanne Collin
  • André-Pierre Contandriopoulos
  • Maria De Koninck
  • Andrée Demers
  • Pierre Joubert
  • Deena White
  • Francine Desbiens
  • Claude Gagnon
  • Daniel Reinharz
  1. 1.Département d’obstétrique et de gynécologieUniversité Laval and Unité des Essais Cliniques - CHUQCanada
  2. 2.Centre de recherche de l’Hôpital Ste-JustineUniversité de Montréal and Unité des Essais Cliniques - CHUQCanada
  3. 3.Unité 149, INSERMParisFrance
  4. 4.Groupe de recherche interdisciplinaire en santéUniversité de MontréalCanada

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