Introduction: In Ontario, prior to 1994, planned home birth attended by midwives was a self-paid service. Since the introduction of regulated midwifery in 1994, home birth is a government-funded service, and uses common resources. As such, there is a need to examine the impact that choice of planned location of birth puts on scarce resources. To date, costs associated with planned place of birth in Ontario have not been evaluated. Objectives: The primary objective is to answer the question: Do planned midwifery-attended home births from the onset of labour cost the Ontario health care system more or less than planned midwifery-attended hospital births from the onset of labour among a comparable low-risk cohort of women? Specifically, this analysis examines the cost of midwifery intrapartum care, from the onset of labour until hospital discharge or the first two days after delivery. Methods: This cost-analysis used a third-party payer perspective (health services costs) to analyze data from the Ontario Midwifery Program, which included 12, 886 midwife-attended births that occurred between April 1, 2003 and March 31, 2006. Three main sources of information were used to determine unit cost and health care utilization: the Ontario Midwifery Program data (2003-2006); data from the Ontario Case Costing Initiative; and the 2010 Schedule of Benefits for Physician Services. Data was analyzed using an intention to treat approach, i.e. based on planned rather than actual location of delivery. Results: Hospital birth is more expensive than planned home-birth. Results were significant with a P value =< .001. The median cost from the onset of labour was $995.95 (IQR $995.95 to $995.95) for planned home birth compared to $2118.12 (IQR $1467.12 to $3610.00) for planned hospital birth. Conclusions: Home birth, a choice that women in Ontario will continue to choose, does not result in costing the Ontario health care system more money. / Thesis / Master of Science (MSc) / This thesis answers the question: Do midwifery-attended planned home births cost the Ontario health care system more or less than midwifery-attended planned hospital births? This thesis examined midwifery-attended births that occurred in Ontario between April 1, 2003 and March 31, 2006 and associated costs that were incurred for both the mother and the baby from the onset of labour until two days following the birth. Since 1994 when midwifery was legislated in Ontario, registered midwives have been providing care to women in both home and hospital settings. While there is general consensus within the midwifery community that home births do not cost the health care system more money, a thorough analysis of costs incurred by midwifery-attended births has not been meaningfully analyzed. Midwifery is the only group of health care professionals providing maternity care that is increasing in size. Given the shortage and the current crisis of maternity care providers, the number of midwives in this province is likely to continue growing. At the same time, a cost analysis of the resources consumed through the provision of maternity care – both at home and at hospital- has not been conducted. This study provides key stakeholders with information regarding resources used and needed and the costs associated with these resources so that resource allocation and planning can be conducted in a responsive manner.

The initiation and duration of exclusive chest/breastfeeding are important health determinants and a key focus of existing public health policy and programs. Despite the demonstrated benefits of chest/breastfeeding and focus on interventions, overall rates of initiation and exclusivity in Ontario remain low. The purpose of this study was to describe how midwifery clients in Ontario - a population credited with high rates of exclusive chest/breastfeeding - access information to support infant feeding decisions. A descriptive, cross-sectional online electronic survey was conducted using the Midwifery Infant Feeding Information Survey questionnaire which was locally developed for this study. A total of 235 midwifery clients who were either in or recently discharged from midwifery care at the time of the survey completed the questionnaire. Data analysis was completed using descriptive statistics with total counts and content analysis for open-ended questions. This research contributes new knowledge about infant feeding information access including the reported usefulness and preferences of various information sources across the continuum of care; the importance of the midwife-client relationship and the online information environment; potential communication gaps in the delivery of comprehensive prenatal infant feeding information; and self-reported infant feeding patterns suggesting midwifery exclusive chest/breastfeeding rates may not be as high as previously thought. Further research to improve information access is needed in order to identify barriers midwives face in discussing infant feeding with clients; explore the effect of health literacy in an online information environment to support the potential development of evidence-based, midwifery-specific online/digital tools. The study findings are relevant for both the academic and clinical midwifery community in developing effective strategies to further support midwifery clients in meeting their infant feeding goals. This study will further inform researchers, public health practitioners, policy makers, and other stakeholders representing all childbearing families in Ontario. / Thesis / Master of Public Health (MPH) / The goal of this study was to examine how midwifery clients in Ontario access information about infant feeding throughout the pregnancy and postpartum period. An online survey of 235 current and former midwifery clients identified why some information sources were more useful than others, and how infant feeding information could become more accessible. The midwife-client relationship and use of online/digital media were identified as important information sources. However, a number of information gaps were identified that suggest not all clients benefit from comprehensive discussions with their midwife in preparation for infant feeding. Further research is needed to understand barriers midwives may face in discussing infant feeding with their clients, and the use of online/digital tools to support midwifery clients to meet their infant feeding goals. The results of this study may benefit all childbearing families in Ontario.

This study examines the oral histories of midwives who practiced in Ontario without legal status in the two decades prior to the enactment of midwifery legislation on December 31, 1993. The following questions are answered: Who were Ontario’s pre-legislation midwives? What inspired and motivated them to take up practice on the margins of official health care? Current scholarship on late twentieth century Ontario midwifery focuses on a social scientific analysis of midwifery’s transition from a grassroots movement to a regulated profession. Pre-legislation midwives are commonly portrayed as a homogenous group of white, educated, middle class women practicing a “pure” midwifery unmediated by medicine and the law. Analysis of the oral history narratives of twenty-one “alegal” Ontario midwives reveals more complex and nuanced understandings of midwives and why they practiced during this period. The midwives’ oral histories make an important contribution to the growing historiography on modern Canadian midwifery.

This study examines the oral histories of midwives who practiced in Ontario without legal status in the two decades prior to the enactment of midwifery legislation on December 31, 1993. The following questions are answered: Who were Ontario’s pre-legislation midwives? What inspired and motivated them to take up practice on the margins of official health care? Current scholarship on late twentieth century Ontario midwifery focuses on a social scientific analysis of midwifery’s transition from a grassroots movement to a regulated profession. Pre-legislation midwives are commonly portrayed as a homogenous group of white, educated, middle class women practicing a “pure” midwifery unmediated by medicine and the law. Analysis of the oral history narratives of twenty-one “alegal” Ontario midwives reveals more complex and nuanced understandings of midwives and why they practiced during this period. The midwives’ oral histories make an important contribution to the growing historiography on modern Canadian midwifery.

Improving the quality of abortion care can reduce stigma, increase access, and enhance knowledge about pregnancy prevention and reproductive health. Midwifery-led medication abortion is considered effective, efficient, accessible, person-centred, equitable, and safe in alignment with the World Health Organization’s framework on quality abortion care. As research on client-centred access to healthcare recommends, Ontario’s expanded midwifery care models are improving the ease with which people can find and use sexual and reproductive services most appropriate to their unique needs. The expanded midwifery care presented in this study demonstrates how midwifery-led medication abortion provides high-quality services, decreases stigma, and improves access to safe, acceptable, and client-centred abortion care, particularly for commonly underserved populations deserving of health equity and Reproductive Justice. / The World Health Organization, the International Confederation of Midwives, and the Canadian Association of Midwives advocate for the inclusion of comprehensive abortion care within midwifery practice. International evidence shows positive outcomes in terms of efficacy, safety, acceptability, and post-abortion contraception uptake when midwives provide abortion services. In Canada, midwifery services are available across various populations, including urban, rural, remote, and Northern areas, suggesting a potential to enhance access and quality of abortion care, particularly for underserved people. Expanding the role of Canadian midwives to include comprehensive abortion care could improve accessibility, address gaps in service provision, support community needs, ensure professional sustainability, foster interprofessional collaboration, and offer continuity of care. Since 2017, the Ontario Ministry of Health has funded Expanded Midwifery Care Models to support midwifery integration, interprofessional collaboration, and delivery of midwifery-led sexual and reproductive care that is not funded under the current payment model. This research explores the individual and shared experiences of midwifery-led medication abortion delivered through Expanded Midwifery Care Models across three distinct regions in Ontario. The study employs interpretive description methodology to understand how midwifery influences the experiences of medication abortion for midwives, collaborating healthcare professionals, and clients. The methodology focuses on exploring how integrating a midwifery model of abortion care supports medication abortion services and promotes Reproductive Justice within primary care settings. By gathering insights from multiple perspectives, the findings hope to inform clinical practice, interest policymakers, and identify outcomes valued by midwives, clients, and healthcare professionals for future research on midwifery-led abortion care. / Thesis / Master of Science (MSc) / Quality abortion care improves the lives, health, and wellness of reproductive-aged people. Abortion is time-sensitive and people face barriers to this care. Reproductive-aged people benefit from healthcare systems that make abortion simple, safe, and effective. Internationally, midwives play a significant role in abortion care by delivering comprehensive services within sexual and reproductive healthcare. In Canada, however, the potential of midwifery in providing abortion care has not been fully realized. As an exception, Ontario’s Expanded Midwifery Care Models (EMCMs) - innovative sexual and reproductive healthcare delivery programs - have made it possible for midwives to provide abortion services. Midwifery-led abortion care in EMCMs includes providing early abortion care in ways that make it easier for people who find it difficult to access care. This research explores and compares the personal and professional experiences of medication abortion care delivered by midwives across three regions in Ontario.