Call the midwife!

USask PhD student Daphne McRae and her supervisor Nazeem Muhajarine, in collaboration with co-supervisor Patricia Janssen and two other UBC researchers, have found a strong association between midwifery care and better birth outcomes for women who struggle with poverty.

In the first study on midwifery care for low-income women in Canada, the researchers have found that low-income pregnant women who receive midwifery care are less likely than women under physician care to have low birth weight babies and premature births, or to give birth to small-for-gestational-age babies — babies less developed than normal for the number of weeks of fetal growth.

“We interpreted these better birth outcomes as being the result of the prolonged contact and extra support given by midwives to pregnant women with difficult backgrounds,” said Muhajarine, U of S professor in community health and epidemiology. 

The researchers analyzed data from almost 58,000 low-income women who used midwifery care in B.C. between 2005 and 2012. Funded by U of S and UBC, the study has been published in the BMJ Open journal (formerly called the British Medical Journal) and presented nationally and internationally.

Previous research in B.C. showed that midwives tend to spend more time with soon-to-be mothers — an average of between 30 and 60 minutes — while physicians’ appointments in B.C. last around 20 minutes.

While midwives, general practitioners and obstetricians are all qualified to provide safe care, each provide a different type of care that women can choose based on their preference.

“Midwives can provide a personalized and comprehensive care, which allows them to address pregnant women’s adverse health and social conditions such as depression, use of substances, and violence,” said McRae, who is now doing post-doctoral research at UBC.

McRae and Muhajarine have found that low-income women with low-to-moderate-risk pregnancies under midwifery care were 34 per cent less likely to deliver low birth weight babies and almost 30 per cent less likely to deliver small-for-gestational-age babies compared to general physicians’ patients.

The women also showed a 26-per-cent reduction in early labour, compared to low-income women exclusively under general physicians’ care.

Compared to obstetricians’ patients in the study, women who relied on midwives experienced a 41-per-cent reduction in delivering small-for-gestational-age babies, and almost half the chance of premature births. 

Among substance-using mothers, U of S researchers noted a 75-per-cent reduction in the chance of premature births for midwives versus obstetricians’ patients.

Pregnant women in the study mostly received care by one group of providers only — either general physicians, obstetricians, or midwives. McRae restricted her study to women who would have been eligible for midwifery care regardless of the practitioner who delivered the baby, and then she controlled for differences in health and lifestyle risks among the three groups.

McRae explains she could not analyze data from Saskatchewan simply because not enough data have been collected over a long period. The Saskatchewan Midwifery Act was implemented in 2008, but to date there are only 13 midwives registered and practising in the province.

“If more midwives were added, Saskatchewan could save money in public healthcare and achieve equal to, if not better, birth outcomes than what we are currently experiencing,” said Muhajarine. “Our research could help develop policies that make the service more accessible to low-income women.”

But Muhajarine cautions more research is needed for a better understanding of costs and to pinpoint which sub-groups among low-income women are benefiting most from midwifery use, so that a more targeted approach in prenatal care can be developed.

Federica Giannelli is a graduate student intern in the U of S research profile and impact unit.

This article first ran as part of the 2018 Young Innovators series, an initiative of the U of S Research Profile and Impact office in partnership with the Saskatoon StarPhoenix.