Integration of midwives into the Quebec health care system

This paper reports on one aspect of the evaluation of the midwifery pilot p rojects in Quebec: the identification of the professional and organizationa l factors, as well as the mode of integrating midwives into the maternity c ars system, that would promote the best outcomes and the autonomy of midwiv es. The research; strategy involved a multiple-case study, in which each mi dwifery pilot project represented a case. Based on a qualitative approach, the employed various sources of data: individual interviews and focus group s with key informants, site observations and analyses of written documents. Results show that midwives were poorly integrated into the health care sys tem during the evaluation. Four main reasons were identified: lack of knowl edge about the practice of midwifery on the part of other health care provi ders; deficiencies in the legal and organizational structure of the pilot p rojets; competition over professional territories; and gaps between the mid wives' and other providers' professional cultures. Recommendations are prov ided to facilitate the integration of midwives into the health care system.