A case study of the implementation of regulated midwifery in Manitoba
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In 2000, midwifery was regulated in the Canadian province of Manitoba. Since the inception of the midwifery program, little formal research has analyzed the utilization of regulated midwifery services. Currently, many women are denied access to midwifery care due to the shortage of midwives in Manitoba. The specific objectives of this mixed-methods case study were to describe the utilization of midwifery health care services in Manitoba from 2001/02 to 2009/10 and to explore factors influencing the implementation and utilization of regulated midwifery services in Manitoba. The study was guided by the Behavioral Model of Health Services Use (Andersen, 1995). Data collection and analysis were an iterative process between documents, interviews, and administrative data. The quantitative analysis used the population-based administrative data housed at the Manitoba Centre for Health Policy to study the utilization of midwifery care. There was modest growth in the overall rate of midwifery-attended births, as well as in the number of midwives over the 10-year time period. Twenty-four key informants were purposefully selected to participate in semi-structured interviews for the qualitative component. Interviews were audio-taped, transcribed verbatim and analyzed using content analysis. Three main topic areas were identified: barriers, facilitators, and future strategies/recommendations. Themes arising under barriers included conflict and power; lack of an educational program; perceptions of the profession, and a precarious profession. Issues of gender underpinned some of these barriers. Constituent influence was a prominent facilitator of the profession. Future strategies for sustaining the midwifery profession focused on ensuring avenues for registration and education, improving management strategies and accountability frameworks, enhancing the work environment, and evaluating the model of practice and employment. Results of the document analysis supported the themes arising from the interviews. In spite of scientific evidence that supports the midwifery model of care, there remains an inherent struggle to justify the profession and ensure its widespread implementation in Manitoba. The findings have implications for maternal child health professionals working on collaborative efforts to facilitate access to midwifery services for women. This study adds to the growing body of literature related to midwifery in Canada.