The Mentored Midwifery Project: A Social Work and Midwifery Research Partnership to Assess the Impact of Midwifery Services at an Urban Community Health Centre

Background and Purpose: The existing literature identifies numerous systemic and personal barriers hindering uninsured, urban, and low socioeconomic status birthing people from accessing adequate prenatal care. These barriers include prohibitive costs for physician specialists, onerous documentation requirements, restrictive catchment areas, and refusal to provide prenatal care to the uninsured. Despite midwifery services being cost free, there is a lack of research on maternal healthcare in Canada, particularly regarding midwifery care.

This collaborative study conducted with the social work and midwifery disciplines evaluated midwifery care services integrated at a community health centre (CHC). The Mentored Midwifery project highlights a promising multidisciplinary approach to improving health equity and birth outcomes for diverse birthing people. This paper examines the qualitative methods and findings of this project.

Methods: This study utilized a mixed methods approach. A retrospective chart review was completed by the midwives, with support from the Social Work Post-Doctoral Fellow, using descriptive statistics to analyze perinatal outcomes. A qualitative analysis was completed by three social workers who conducted ten in-depth, semi-structured interviews with former clients of the midwifery services. The qualitative sample comprised predominantly Asian individuals (40% Asian; 30% Black; 20% Hispanic/Latino; 10% unknown), between the ages of 25-34 (80% young adults, 25-34; 10% adults, 35-42; 10% youth, 19-24). Participants were recruited using probability sampling, through email invitations sent to previous clients. The interviews captured participants’ narratives encompassing their experiences with the midwifery program and general health care services, the health education and support received, and challenges in accessing prenatal services. Guided by the principles of grounded theory, the interviews were transcribed verbatim and thematically coded using Atlas coding software. Utilizing a social justice lens, social workers provided analysis and interpretation of the qualitative data collected.

Results: Data analysis reveals that the midwifery model of care prioritized their choice and control which led to participants receiving dignified and client-centred care. Participants described feeling supported and cared for throughout their pregnancy. Further, the data emphasizes the midwifery care model’s ability to respond to participant needs urgently and compassionately, noting high levels of confidence in their midwives’ knowledge and cultural safety. The findings suggest that integrated services allow clients to promptly access prenatal care in a familiar setting, where they are already comfortable receiving care.

Additionally, some participants reported that gaps in communication among healthcare providers internal and external to the CHC created challenges. Findings indicate that being a newcomer to the Canadian healthcare system often exacerbated the complexity of navigating these challenges. Participants suggested that more streamlined communication would offer clarity regarding what to expect during their care journey.

Conclusions and Implications: The midwifery model of care is equipped to meet the care needs and expectations of diverse groups. Results also indicate that CHCs are excellent partners for midwifery services as they serve diverse individuals in accessible, non-stigmatizing, community-based settings. This study offers social work an advocacy opportunity to advance social justice in healthcare by expanding perinatal care pathways to all residents regardless of their social location.