Midwives' Belief in Normal Birth: The Canadian Survey of Maternity Care Providers’ Attitudes Toward Labour and Birth

Patricia McNiven, RM, PhD, Michael C. Klein, MD, Nazli Baradaran, MD, Jocelyn Tomkinson, BSc, Stephen J. C. Hearps, BPsyc, PGDipPsyc, Lee Saxell, RM, MA

ABSTRACT
Background: Midwifery has been integrated into the health care systems of over half of Canadian provinces and territories. While there are differences in legislation and payment mechanisms, the model of midwifery is fairly similar across the country. This study examined the similarities and differences among midwives' attitudes toward labour and birth. In addition, we compared items which related to beliefs about normal birth between midwives and other care providers.
Methods: A national cross-sectional survey was conducted comparing maternity care providers’ beliefs about childbirth and intra-professional variations in midwives' attitudes towards birth. There were 400 (54%) midwife respondents: 218 from Ontario, 75 from B.C, 53 from Quebec, 48 from the remaining regulated or pre-regulated provinces (six missed information for this field).
Results: All midwives were critical of the routine use of interventions such as episiotomy, epidural analgesia and electronic fetal monitoring (EFM). There was strong agreement about the safety of home birth, out of hospital birth centres and the importance of women's autonomy and decision-making in pregnancy and birth. However, some regional variations were identified. Quebec midwives were more opposed to epidural analgesia than BC and Ontario (p<.001), and were more likely to believe that cesarean birth is more costly than vaginal birth (p=.005). Ontario midwives were most likely to believe that cesarean birth protects against urinary incontinence (p=.001), and sexual dysfunction (p=.002). Qualitative comments of midwives indicated a strong desire to reduce unnecessary medical intervention and to lower cesarean section rates.
Conclusion:
Canadian midwives share similar beliefs regarding place of birth, the routine use of episiotomy, EFM, and epidurals, but reported significant attitudinal differences for other issues. Regional differences may be related to midwives' primary practice settings, the historical development of midwifery in their region and the number of new midwives with less than 5 years of clinical experience. A set of core midwifery values was identified that demonstrate a strong belief in normal birth.

KEYWORDS
normal birth, midwifery, attitudes of health professionals, cesarean section, home birth, labour, intrapartum technology, out-of-hospital birth

This article has been peer reviewed.