Midwifery Care in Eight Industrialized Countries: How Does Canadian Midwifery Compare?

OBJECTIVES: Much has been written about the status of midwifery in developing countries, yet there is limited knowledge and analysis of the role of midwifery in the provision of maternity care in the developed world. The purpose of this study was to better understand how midwifery in Canada compares with midwifery in other developed countries with particular attention to educational preparation, scope of practice, and the contribution of midwives to the overall provision of maternity care. METHODS: Eight countries were selected on the basis of comparably low maternal mortality rates (defined as < 10/100,000 live births). Document analysis and a survey of key informants were used to develop an understanding of the role of midwifery in the various jurisdictions. We then undertook an analysis of similarities and differences among models. RESULTS: Variations in models of midwifery exist within and among the countries studied. Midwifery in Canada is most similar to midwifery in the Netherlands and New Zealand with regard to the model of practice, continuity of care, choice of birth place and degree of autonomy. CONCLUSION: Midwifery in Canada is growing, but offers a relatively small contribution to the national provision of maternity services in comparison with other countries. The growth of midwifery in Canada may play a key role in lowering intervention rates and strengthening maternity care as is evidenced in other industrialized nations where midwifery care is an integral part of maternity services.