Community As Client: A Qualitative Descriptive Study of the Work of Midwives to Increase Access to Midwifery Care
Lisa Nussey, RM, BSc, Tonya MacDonald, RM, MPH, Beth Murray-Davis, RM, PhD, Meredith Vanstone, PhD, and Elizabeth K. Darling, RM, PhD
Increasing access to midwifery care for disadvantaged groups was an explicit goal of the regulation of midwifery in Ontario. However, people of low socio-economic status (SES) remain less likely to receive midwifery care. We conducted a qualitative descriptive study to explore the work midwives do to make midwifery care accessible to people of low SES. We interviewed 13 Ontario midwives serving people of low SES, who practiced midwifery in settings ranging from a remote solo practice to a large urban practice. Participants described a broad range of ways in which they work to enhance the approachability, acceptability, availability and accommodation, affordability, and appropriateness of their services for people of low SES. We identified two distinct approaches to increasing access to care: (1) working to maximize the existing beneficial aspects of the midwifery model to whoever presents to care, and (2) stepping outside of the confines of the midwifery model, to provide what we call “community-centred care,” in which midwives are both a part of and responsive to the broader communities that they serve. The intentional, pro-active approach used by midwives providing community-centred care could be implemented more broadly to improve access to midwifery care for people of low SES.
midwifery; health services accessibility; social class; health care quality, access, and evaluation; community health services; health services; Indigenous