A Qualitative Assessment of Factors in the Uptake of Midwifery Among Diverse Populations in Thunder Bay, Ontario
Helle Møller, PhD, Martha Dowsley, PhD, Pamela Wakewich, PhD, Lisa Bishop, BHSc, Kristin Burnett, PhD, and Mackenzie Churchill, HBSc
Introduction: Although the uptake of midwifery in Thunder Bay, Ontario, is above the provincial average, it is well below the World Health Organization–suggested level. Midwifery is especially underutilized by Indigenous women and by recent immigrant, refugee, and asylum-seeking women.
Objective: To explore factors shaping birth-attendant choices and decisions of diverse women in northwestern Ontario.
Methods: Drawing on data from a larger pilot study, this paper discusses factors in choosing midwifery for Indigenous, Euro-Canadian, and visible-minority (VM) women in Thunder Bay. Using in-depth interviews, we explored where the women obtained information regarding birth-attendant options, how and why they chose their caregiver, and their perceptions of the quality of their maternal care experiences.
Results: Participating women’s birth-attendant choices and experiences were influenced by (1) health care provider and/or social network awareness of (and attitudes towards) midwifery; (2) personal knowledge; (3) access to midwifery; and (4) understanding of the pregnancy as being on a medical risk continuum or as a normal, healthy process. Additional influences for VM women include a lack of formally educated midwives and social status gained through having a physician in their country of origin. Additional influences for Indigenous women were the effects of colonization, discrimination, and racism.
Conclusion: Women (particularly VM and Indigenous women), their families, and health care providers in northwestern Ontario need more and easier access to midwives and to knowledge about their services and scope of practice. Also, increased focus on antiracist and culturally safe practice in health care provider curricula would help improve care for Indigenous women.
midwifery, health care providers, Indigenous population, ethnic groups, Ontario