Interest in home and birthing centre delivery and in midwife care for women at low risk has been growing recently.[1–4] In the past few years in Canada, several provincial governments have legislated midwife care, and other provinces are considering doing so. However, the appropriateness of these new models of health care delivery remains controversial.[1–9] Although the desire among women at low risk for natural childbirth has been considered a driving force behind the interest in birthing centre and midwife care,[1–4] the attitudes of Canadian women towards alternative forms of care and the factors affecting those attitudes are largely unknown. As a first attempt to fill this gap, we analysed data from the 1994 National Population Health Survey for 3438 women aged 20 to 44 years; at the time of the survey, there were 5 687 000 Canadian women in this age group.
The design and methods of the 1994 supplement cycle of the National Population Health Survey have been described in detail elsewhere.10 All analyses in this article are based on weighted estimations (i.e., for the projected Canadian population, rather than the actual sample). The results are expressed as proportions (or percentages) of eligible female respondents (excluding the 14% of respondents who did not want a child or who did not respond) who answered Yes to the 3 questions about birthing centres and midwife care for childbirth.
Just under one-third of respondents (31%, 95% confidence interval [CI] 28% to 33%) answered Yes to the question "Would you go to a birthing centre, rather than a hospital, to have a baby?" Of these, only two-thirds (71%, 95% CI 71% to 72%), or about 21% of all respondents, said they would allow a nurse or midwife rather than a doctor to deliver the baby. About 85% of the respondents (95% CI 83% to 88%) answered Yes to the question "Would you allow a nurse or midwife rather than a doctor to give postpartum care?" Women who had less education, those who were new immigrants, and those who did not speak English or French were much less likely to answer Yes to all 3 questions (Table 1). In contrast, no strong associations were found between health-related factors and women's acceptance of birthing centres or nurse or midwife care for childbirth (Table 1).
These results demonstrate that a substantial proportion of Canadian women of reproductive age would be willing to deliver at a birthing centre and to receive childbirth and postpartum care from a nurse or midwife. Low education and social and language difficulties are more important determinants of attitudes towards these alternative forms of care than women's general health status. Our findings may be helpful in planning health care services for pregnant women. To yield more useful information, future surveys should include more detailed questions and should be conducted in communities where birthing centres or nurse or midwife care (or both) have already been implemented.
This study was carried out under the auspices of the Canadian Perinatal Surveillance System. Dr. Kramer is a Distinguished Scientist of the Medical Research Council of Canada.
Competing interests: None declared.
Footnotes
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Reprint requests to: Dr. Shi Wu Wen, Bureau of Reproductive and Child Health, Laboratory Centre for Disease Control, Health Canada, Tunney's Pasture A-L 0601E2, Ottawa ON K1A 0L2; fax 613 941-9927; [email protected]