Playing nice: improving the professional climate between physicians and midwives in the Calgary area

Anecdotal reports in the Calgary area indicate a lack of integration of midwives into the mainstream obstetrical community and strained relationships between obstetrical care providers. Finding ways to cultivate positive working relationships is essential for ensuring excellent patient care standards. In this study we sought to identify barriers to an effective working relationship between physicians (both obstetricians and family physicians) and midwives, and to find ways to improve the quality of professional interactions and promote team-based pregnancy care.

We conducted a mail survey within the former Calgary Health Region that included questions about professional interaction, philosophy regarding childbirth, and relationships between obstetrical practitioners. Participants included family physicians (FPs), midwives (MWs), and obstetricians (OBs) who were identified from publicly available lists.

The overall response rate was 80% (144/180). Eligible responses were received from 56 FPs (89% female, 45% in practice < 10 years), 25 MWs (100% female, 68% < 10 years), and 37 OBs (60% female, 49% < 10 years). Responses in agreement with selected survey statements were as follows: childbirth is a dangerous process (36% FPs, 1% MWs, 57% OBs); there are many unnecessary Caesarean sections performed (23% FPs, 76% MWs, 27% OBs); MWs are well-trained professionals (68% FPs, 100% MWs, 30% OBs); residents would benefit from learning from midwives (61% FPs, 100% MWs, 38% OBs); and working relationships could be improved (89% FPs, 100% MWs, 97% OBs).

Relationships between physicians and midwives are sometimes strained. Potential solutions include increased integration in learning, joint attendance at meetings and rounds, and increased opportunities for collaboration.