Ontario care providers' considerations regarding models of maternity care

There is currently a crisis in the delivery of maternity care in Canada, in part due to the significant decline in the number of professionals who provide intrapartum care. This study was undertaken (1) to elicit care providers' opinions regarding seven proposed models of maternity care, (2) to explore barriers to collaborative interprofessional practice, and (3) to identify factors that would encourage the practice of intrapartum care.

A survey seeking opinions about models of care, perceived barriers to interprofessional collaboration, and factors that might encourage practising intrapartum care was mailed to all registered midwives (N = 322) and obstetricians (N = 647) in Ontario and to a stratified random sample of family physicians (N = 750) in Ontario.

Completed questionnaires were received from 80% of midwives, 64% of obstetricians, and 66% of family physicians. Midwives and obstetricians endorsed uniprofessional models and indicated an interest in multiprofessional practice. Family physicians were reluctant to choose any models that would have them practising intrapartum care. However, family physicians currently providing intrapartum care would consider the uniprofessional model in which they delivered the babies of the women they were caring for unless they were signed out. Midwives identified different philosophies of care as the main barrier to collaborative interprofessional maternity care (60.7%); obstetricians and family doctors identified liability and insurance issues (60.3% and 38.7%, respectively). An adequate on-call arrangement was the key factor potentially encouraging midwives and obstetricians to provide intrapartum care (70.3% and 70.0%, respectively). For family physicians, good medical and obstetrical back-up was the first priority (70.8%), followed by on-call arrangements.

A variety of models for providing intrapartum care must be available, as no single model meets the needs of all maternity providers. Attention must be given to eliminating barriers to collaborative interprofessional practice, coupled with enhancing factors that facilitate the delivery of intrapartum care.