Maternity Service Delivery in Manitoba, Canada: A Retrospective Analysis of Three Maternity Care Provider Types
Notice bibliographique
Résumé
Background: Alleviating shortages in health workforce and delivery of efficient maternity care models are unresolved policy issues in Canada. In the province of Manitoba, obstetricians do the majority of maternity care, family practice physicians take care of low-risk women, and midwives continue to deliver care to about 5% of the low-risk pregnant women. The purpose of this study was to describe how maternity care is provided in Manitoba, based on a revised definition of Most Responsible Provider, and to compare maternal and perinatal outcomes by provider type. Methods: Administrative data were used from the Manitoba Centre for Health Policy (MCHP) to select women who had a low-risk pregnancy. Descriptive statistics and logistic regression were used to examine differences in types of intervention, mode of delivery, and outcomes by provider type among low-risk women. Logistic regression models controlled for socio-demographic and birth-related covariates. Results: From 2004/05 to 2012/13, there were a total of 132,918 births in Manitoba. Of those births, 47,083 were identified as high risk (35%), and 85,835 (65%) were identified as low risk. Key findings demonstrate midwifery care compared to obstetrical care was associated with lower odds of interventions such as cesarean section (0.47 [0.40–0.54]), induction (0.42 [0.39–0.49]), and episiotomy (0.48 [0.41–0.55]), but higher odds of postpartum hemorrhage (1.35 [1.18–1.55]), and shorter lengths of stay in hospital (-0.58 [-0.61-0.56]). Family practice physicians also had decreased odds of assisted vaginal delivery (0.82 [0.76–0.89]), epidural use (0.59 [0.57–0.62]) and third- and fourth-degree tears (0.82 [0.73–0.92]), but higher odds of augmentation (1.06 [1.01–1.11]). Results reported for midwives and family practice are compared to obstetricians. Conclusions: A health workforce strategy that optimizes how to address the maternity care needs in the province of Manitoba is needed. There is suboptimal integration of midwifery services that could meet the low-risk population needs. Human health workforce development requires a good understanding of each provider’s role, opportunities for collaboration and integration to be strengthened, and the potential to optimize the outcomes for mothers and infants. This article has been peer reviewed.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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