Midwifery Care is Safe for Moderate & High-risk Pregnancies

Contrary to a common misconception that midwives primarily manage low-risk pregnancies, new UBC research demonstrates that midwives in British Columbia are delivering safe primary care for high-risk pregnancies.

The research, which was written up in the Canadian Medical Association Journal, looked at births that occurred in British Columbia between 2008 and 2018. The results of births for women who had a midwife as their most responsible provider (MRP) were compared to those for women who had a family doctor or obstetrician as their MRP.

The results show that, regardless of medical risk level, women who had a midwife as their MRP experienced birth outcomes that were equivalent to or better than those who received care from a family doctor or an obstetrician.

“The study provides evidence that midwifery care in B.C. is a safe and effective option for childbearing people, regardless of medical risk,” said Dr. Kathrin Stoll, a research associate in UBC’s department of family practice. “As medical risk increases, midwives and family physicians collaborate with obstetrician specialists to ensure that birthing people are receiving safe and appropriate care that is right for them.”

The researchers say the findings are a reflection of how midwives are integrated into B.C.’s health system.

“Midwives operate in two worlds: They are in the community working with people in their homes, but they are also integrated into the hospital system,” said Dr. Stoll. “When complications develop, midwives are a bridge to the specialist and hospital care that a person needs.”

Although the rate of cesarean delivery increased as medical risk increased, midwifery clients continuously had lower cesarean delivery rates than people with physician MRPs. The greatest percentage of cesarean deliveries in the nation—close to 37%—occurred in British Columbia in 2019–2020.

Midwifery Care in High-risk Pregnancies

The latest research demonstrates how midwifery treatment in British Columbia has changed since it was recognized as a health profession in 1998.

From 9.2 percent in 2008 to 19.8 percent in 2018, a midwife Nurse was present for a greater percentage of deliveries. Midwives now participate in the highest percentage of births in Canada—nearly a third—in B.C. as a result of recent increases in that percentage.

“Whereas midwifery care may have started out primarily with low-risk clients, the study provides evidence that the profile of clients is changing and that midwives are increasingly caring for clients safely at all medical risk levels,” said Dr. Stoll.

The researchers say they were not surprised by the findings because medical risk has always been a core part of the profession.

“A large part of midwifery education is teaching students about medical complexities and how to triage clients in terms of their medical risk. It’s always been a part of midwifery training and the care midwives provide,” says Dr. Luba Butska, an assistant professor of teaching with UBC’s midwifery program in the department of family practice.

Canada has some of the lowest rates of midwifery access in the world and rising rates of cesarean deliveries, despite increases in midwifery services during the research period.

According to the study, regulations, and payment systems that encourage midwives to stay in the field should be promoted, along with collaboration amongst medical colleagues and health system integration.

“As the midwifery profession continues to grow in Canada, it holds potential for meeting national mandates to lower obstetric intervention rates and to increase access to midwifery care to under-served communities,” said Dr. Butska. “It’s the combination of good outcomes and lower intervention rates that make midwifery a great public health strategy.”

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