Facilitating the Implementation of Midwifery Services: The Case of Montérégie, Quebec

Nathalie Clavel, MSc, PhD(c); Caroline Paquet, MSc, PhD(c); and Régis Blais, PhD

ABSTRACT
Objectives: This study analyzed midwifery services implementation in one region (Montérégie) of Quebec. The objectives were to determine whether services were implemented as planned and to identify factors that facilitated or impeded implementation. The aspects studied included organizational components; types of midwifery services provided; levels of interprofessional collaboration among midwives, physicians, nurses, and community organizations; and training activities offered to perinatal care providers and students.
Methods: This is a qualitative case study of one implementation experience and is based on three data sources: individual interviews and focus groups; policy and administrative documents related to the implementation; and a database compiled by the midwives on services provided. Data were collected and analyzed between July 2012 and March 2013. 
Results: The implementation of midwifery services in Montérégie was successful and largely accomplished as planned. Its success was due to the alignment of two categories of favourable conditions. The first category consisted of appropriate policies and regulations, demand from service users, and support from front-line professionals. The second category concerned the implementation process and governance and included effective governance structures and mechanisms, dedicated resources, and leadership from champions.
Conclusion: The lessons from this study can be usefully applied to the introduction of midwifery services in jurisdictions where they are not currently present. They may also inform the implementation of other publicly funded health services or professionals in other jurisdictions.

KEYWORDS
midwifery, perinatal care, implementation factors, delivery of health care, integrated

This article has been peer reviewed.