Comparison of midwifery care to medical care in hospitals in the Quebec pilot projects study: Clinical indicators

The purpose of this study was to compare indicators of process and outcome of midwifery services provided in the Quebec pilot projects to those associ ated with standard hospital-based medical services, Women receiving each ty pe of care (961 per group) were matched on the basis of socio-demographic c haracteristics and level of obstetrical risk. We found midwifery care to be associated with less obstetrical intervention and a reduction in selected indicators of maternal morbidity (caesarean section and severe perineal inj ury). For neonatal outcome indicators, midwifery care was associated with b enefits and risks: fewer babies with preterm birth and low birthweight, but a trend toward a higher stillbirth ratio and more frequent requirement for neonatal resuscitation. The study design does not permit to conclude that the associations were causal in nature. However, the high stillbirth rate o bserved in the group of women who were selected for midwife care raises con cerns both regarding the appropriateness of the screening procedures for ad mission to such care and regarding quality of care itself.