A program delivering collaborative maternity care resulted in fewer caesarean sections, shorter average hospital stays and higher breastfeeding rates for mothers, according to researchers at the University of British Columbia and the Child & Family Research Institute.
The findings, published today in the CMAJ (Canadian Medical Association Journal), are based on a study of 1,238 women attending the South Community Birth Program in Vancouver between 2004 and 2010. The program’s midwives, family physicians, nurses and doulas provide care as a team, with many of the women and their partners receiving some of their care and counseling in a group setting. The study compared those women’s outcomes with an equal number of women receiving standard care at other sites.
In addition to the lower rates of caesarean sections (21 per cent in the program compared with 31 per cent in standard care), shorter hospital stays (51 hours compared with 73 hours) and higher breastfeeding rates (86 per cent compared with 62 per cent), women in the South Community Birth Program were more likely to be cared for by a midwife instead of an obstetrician, and less likely to use an epidural injection for pain relief.
The number of doctors providing maternity care has declined significantly over the last two decades, and is expected to shrink further due to retirements. At the same time, the rate of caesarean sections, which places an extra burden on the health care system because of longer hospital stays and associated complications, has increased. The introduction of regulated midwives is helping, although they currently attend less than 10 per cent of births.
The South Community Birth Program was established to deliver comprehensive care from a collaboration of family doctors, midwives, public health nurses and doulas to an ethnically diverse, low-income population.
“Primary maternity care providers are in short supply in Canada, particularly in rural areas, so we need to find a way to deliver optimal care in the most effective way possible,” said lead author Patricia Janssen, a professor in UBC’s School of Population and Public Health, and a scientist at the Child & Family Research Institute. “We don’t know which components of the collaborative, shared-care model were responsible for the differences, but clinicians working in the program believe that it stems from their close working relationship and ability to learn from each other. These findings should encourage the implementation and evaluation of this interdisciplinary approach in other maternity care settings.”
The study was conducted by researchers at UBC’s School of Population and Public Health, Department of Family Practice and School of Nursing, as well as BC Women’s Hospital & Health Centre, an agency of the Provincial Health Services Authority, and the Child & Family Research Institute.