Daphne McRae
University of Saskatchewan
Daphne McRae is a PhD Candidate in the Department of Community Health and Epidemiology at the University of Saskatchewan, Canada. She is also a Trainee at the British Columbia Children's Hospital Research Institute, Canada. Her research interests include maternal infant health for vulnerable populations, health equity, and midwifery care.
Background: In Canada, women with low to moderate pregnancy risk can chose to receive antenatal care from a midwife, obstetrician, or general practitioner, depending on availability. For women of low socioeconomic position,... [ view full abstract ]
Background: In Canada, women with low to moderate pregnancy risk can chose to receive antenatal care from a midwife, obstetrician, or general practitioner, depending on availability. For women of low socioeconomic position, antenatal midwifery care (similar to case-load midwifery care) has been shown to improve birth outcomes in some North American studies, though conclusions based on the literature have been limited by methodological weaknesses within studies, small sample sizes, diverging results, and few recent studies.
Purpose: To determine among women with low socioeconomic position, if antenatal midwifery vs. obstetrician or general practitioner care significantly reduced the odds of small-for-gestational-age birth and/or preterm birth.
Methods: Eligibility for this population-level, retrospective cohort study was based on low to moderate risk pregnancy, to residents of British Columbia, Canada, who had singleton births (2005- 2012), no more than two provider-types involved in care, and received medical insurance premium assistance (n=57,872). Administrative maternity and billing data were merged with neighbourhood and community-level health equity data from four provincial sources. Logistic regression models were used to control for confounding.
Results: Odds of small-for-gestational-age birth were reduced for midwives’ vs. obstetricians’ patients (adjusted OR 0.60, 95% CI: 0.51-0.70), and vs. general practitioners’ patients (AOR 0.73, 95% CI: 0.63-0.84). Likelihood of preterm birth was reduced for midwives’ vs. obstetricians’ patients (AOR 0.53, 95% CI: 0.45-0.62), and vs. general practitioners’ patients (AOR 0.74, 95% CI: 0.63-0.86). In sub-group analyses, odds of small-for-gestational-age birth were even further reduced for midwifery vs. obstetrician patients who were substance using (AOR 0.30, 95% CI: 0.13-0.68). Women with both a mental health diagnosis and substance use during pregnancy had even lower odds of small-for-gestational-age birth if in the care of a midwife vs. an obstetrician (AOR 0.19, 95% CI: 0.05-0.72). Substance using midwifery patients were also less likely to have preterm birth (AOR 0.25, 95% CI: 0.12-0.52), vs. obstetrician patients.
Conclusions: For women with low socioeconomic position, antenatal midwifery care reduced the likelihood of small-for-gestational-age birth and preterm birth compared to obstetrician or general practitioner care. These associations were stronger among midwifery vs. obstetrician patients with low socioeconomic position and other socially complex conditions.
Studies of and contributions to practice and/or service organisation , The identification and examination of relevant outcomes relating to labour and birth , Methodological innovations inthis and associated areas
