Evaluation of the midwifery pilot projects in Quebec: An overview

In 1990, the province of Quebec adopted a law authorizing the evaluation of the practice of midwifery through eight pilot projects. The projects, which took the form of birth centres outsides, started operating in 1994. The objectives of the evaluation were 1) to compare midwives services to current physician services ito maternal and neonatal mortality and morbidity, the use of obstetrical intervention, individualization and continuity of care as perceived by clients, and cost; and 2) to identify the professional and organizational factors associated with the integration of midwives into the care system. A mixed evaluative design a multiple case study with each pilot representing a case and a cohort study where 1,000 women followed by midwives in the birth centres were marched with 1,000 women followed by physicians in the usual hospital-based services. Various quantitative and qualitative data collection instruments were used. Overall, many results were favourable to midwifery practice, while some were favourable to medical care. Following the evaluation, the Government of Quebec decided to legalize the practice of midwifery.