Experiences of midwifery learners in the midwifery clinical areas
- Authors: Makhate, Moliehi Thelma
- Date: 2012-06-07
- Subjects: Midwifery , Learner midwives , Midwifery education
- Type: Mini-Dissertation
- Identifier: uj:8679 , http://hdl.handle.net/10210/5034
- Description: M.Cur. , Several studies have highlighted the need to support and nurture learner midwives and address the potentially stressful nature of their experiences; particularly around the qualified staff in hospitals for example Begley (2001). A qualitative research design will be used to explore and describe the experiences of learner midwives in the midwifery clinical areas. The data collection method will be in-depth interviews. The population will comprise second level learners registered for a Diploma in Nursing (General, Psychiatry, Community) and Midwifery at a Nursing Education Institution in Gauteng. Due to the qualitative nature of the study, sampling will continue until data is saturated. Non probability, purposive sampling will be used. The inclusion criteria will include learners who are practising in Midwifery clinical areas for example labour and post natal wards in an academic hospital, who are able to communicate in English and are capable of giving informed consent. The sampling is purposive because the researcher had to increase theoretical understanding of some fact of the phenomenon being studied Burns & Grove (2005: 376), namely the experiences of learner midwives in the clinical midwifery areas.
- Full Text:
- Authors: Makhate, Moliehi Thelma
- Date: 2012-06-07
- Subjects: Midwifery , Learner midwives , Midwifery education
- Type: Mini-Dissertation
- Identifier: uj:8679 , http://hdl.handle.net/10210/5034
- Description: M.Cur. , Several studies have highlighted the need to support and nurture learner midwives and address the potentially stressful nature of their experiences; particularly around the qualified staff in hospitals for example Begley (2001). A qualitative research design will be used to explore and describe the experiences of learner midwives in the midwifery clinical areas. The data collection method will be in-depth interviews. The population will comprise second level learners registered for a Diploma in Nursing (General, Psychiatry, Community) and Midwifery at a Nursing Education Institution in Gauteng. Due to the qualitative nature of the study, sampling will continue until data is saturated. Non probability, purposive sampling will be used. The inclusion criteria will include learners who are practising in Midwifery clinical areas for example labour and post natal wards in an academic hospital, who are able to communicate in English and are capable of giving informed consent. The sampling is purposive because the researcher had to increase theoretical understanding of some fact of the phenomenon being studied Burns & Grove (2005: 376), namely the experiences of learner midwives in the clinical midwifery areas.
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Experiences of midwives when caring pregnant immigrant women in a public hospital
- Koneshe, Mamokgadi Gloria Victoria
- Authors: Koneshe, Mamokgadi Gloria Victoria
- Date: 2014
- Subjects: Midwifery , Pregnant immigrant women , Public hospitals
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/17664 , uj:15910
- Description: M.Cur. (Midwifery and Neonatal Nursing Science) , Abstract: Midwives meet challenges when caring for pregnant immigrant women. This is brought about by factors that include cultural diversity, and the increased number of patients to be cared for in clinical facilities. Additionally some clinical facilities ill equipped in terms of staff and equipment, and this has resulted in some health professionals feeling that resources should be used for South Africans only. The purpose of this study is to explore and describe the experiences of midwives caring for pregnant immigrant women, and to formulate recommendations to assist midwives in caring for pregnant immigrant women. A qualitative, explorative and contextual research design was utilized. The research took place in two phases. Phase one focused on the exploration of the experience of midwives when caring for pregnant immigrant women. A Convenience sample of midwives was included in this study. Semi-structured phenomenological interviews were conducted until data saturation was reached. The data was analyzed by means of open coding. The results were re-contextualized into the literature. In phase two, recommendations were formulated from the outcomes of phase one to assist midwives caring for pregnant immigrant women. Ethical principles were applied in this study. Measures of trustworthiness were adhered to.
- Full Text:
- Authors: Koneshe, Mamokgadi Gloria Victoria
- Date: 2014
- Subjects: Midwifery , Pregnant immigrant women , Public hospitals
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/17664 , uj:15910
- Description: M.Cur. (Midwifery and Neonatal Nursing Science) , Abstract: Midwives meet challenges when caring for pregnant immigrant women. This is brought about by factors that include cultural diversity, and the increased number of patients to be cared for in clinical facilities. Additionally some clinical facilities ill equipped in terms of staff and equipment, and this has resulted in some health professionals feeling that resources should be used for South Africans only. The purpose of this study is to explore and describe the experiences of midwives caring for pregnant immigrant women, and to formulate recommendations to assist midwives in caring for pregnant immigrant women. A qualitative, explorative and contextual research design was utilized. The research took place in two phases. Phase one focused on the exploration of the experience of midwives when caring for pregnant immigrant women. A Convenience sample of midwives was included in this study. Semi-structured phenomenological interviews were conducted until data saturation was reached. The data was analyzed by means of open coding. The results were re-contextualized into the literature. In phase two, recommendations were formulated from the outcomes of phase one to assist midwives caring for pregnant immigrant women. Ethical principles were applied in this study. Measures of trustworthiness were adhered to.
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Sustainability of midwifery practice within the South African healthcare system
- Authors: Dippenaar, Johanna Maria
- Date: 2012-09-04
- Subjects: Midwifery , Medical care , Public-private sector cooperation
- Type: Thesis
- Identifier: uj:3497 , http://hdl.handle.net/10210/6887
- Description: M.Cur. , The study on ‘Sustainability of midwifery practice within the South African healthcare system’ is stimulated by the lack of research that influences policy to support midwifery practice in South Africa. The poor database and health information systems for midwives result in the poor performance of maternal healthcare in the public sector (Parkhurst, Penn- Kekana, Blaauw, Balabanova, Danishevski, Rahman, Onama, & Ssengooba 2005) in spite of meeting the Safe Motherhood Initiative of the World Health Organisation’s criteria for skilled attendance and facilities (Penn-Kekana & Blaauw 2004). Generally, midwives remain the main provider of maternal healthcare, including South Africa, where only 3 in 10 women in the public sector see a medical doctor once in pregnancy (South African Demographic Health Survey 1998). The norms and standards recommended by the Saving Mothers Reports 1998 – 2006 for staffing and resources to improve outcomes of maternal deaths have not realised. The public sector needs help from the private sector for improved care. The Nursing Strategy for South Africa 2008 endorses Public-Private Partnerships (PPP) to support nursing and midwifery. There is no Public- Private Partnership in South Africa to support or sustain midwifery practice. The purpose of the study is to develop a model for a Public-Private Partnership for midwifery practice sustainability in the South African healthcare system. This study follows adapted explorative, descriptive, model generating research guidelines of Chinn and Jacobs (1983 & 1987), Chinn and Kramer (1991 to 2008) and Walker and Avant (1995). Analysis of the South African maternal healthcare context uses the open-system theory for sustainability of Olsen and a team of researchers (1998) and several frameworks for healthcare human resources. The main concepts of the model are identified and analysed. The main concepts are Public-Private Partnership, midwifery practice, sustainability and the related concepts are governance, task environment and quality service. The model for a Public-Private Partnership is synthesised through the relation of concepts. The 45 statements of the context empirically ground the study. The model depicts the South African healthcare context and all the factors that impact on midwifery and its context. The model and its functions are explained within a constituted framework. The Global standards for practice of the International Council for Nursing and Midwifery, the definition and core competencies of midwives of the Confederation of Midwives, the Millennium Development Goals for Sub-Sahara Africa 2020 and the newly formed World Health Organisation Partnership for Africa for maternal, newborn and child care 2008 are factors of the global (macro) context that influence the model. The South African healthcare system (meso context) factors include economics, legal-ethical, professional, service delivery and civil society dimensions that impact on policy for service delivery on micro level, where the PPP formally exists. The PPP for maternal healthcare is developed within this framework. The stakeholders of the formal PPP are the public sector, the private sector, the midwifery profession and civil society. The PPP governs the task environment for midwifery through the risk assessment strategies that include financial risk based on clinical risk and the development of norms and standards for staff and resources as expressed in service level agreements for quality service delivery. Governance implies policy standards and the accountability of the PPP to the consumer for service delivery quality and performance. The stakeholders of the PPP ensure sustainability in this model through collaboration and shared responsibility, risk and decision-making between the institution, midwifery profession and practice and civil society for a balance of interest.
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- Authors: Dippenaar, Johanna Maria
- Date: 2012-09-04
- Subjects: Midwifery , Medical care , Public-private sector cooperation
- Type: Thesis
- Identifier: uj:3497 , http://hdl.handle.net/10210/6887
- Description: M.Cur. , The study on ‘Sustainability of midwifery practice within the South African healthcare system’ is stimulated by the lack of research that influences policy to support midwifery practice in South Africa. The poor database and health information systems for midwives result in the poor performance of maternal healthcare in the public sector (Parkhurst, Penn- Kekana, Blaauw, Balabanova, Danishevski, Rahman, Onama, & Ssengooba 2005) in spite of meeting the Safe Motherhood Initiative of the World Health Organisation’s criteria for skilled attendance and facilities (Penn-Kekana & Blaauw 2004). Generally, midwives remain the main provider of maternal healthcare, including South Africa, where only 3 in 10 women in the public sector see a medical doctor once in pregnancy (South African Demographic Health Survey 1998). The norms and standards recommended by the Saving Mothers Reports 1998 – 2006 for staffing and resources to improve outcomes of maternal deaths have not realised. The public sector needs help from the private sector for improved care. The Nursing Strategy for South Africa 2008 endorses Public-Private Partnerships (PPP) to support nursing and midwifery. There is no Public- Private Partnership in South Africa to support or sustain midwifery practice. The purpose of the study is to develop a model for a Public-Private Partnership for midwifery practice sustainability in the South African healthcare system. This study follows adapted explorative, descriptive, model generating research guidelines of Chinn and Jacobs (1983 & 1987), Chinn and Kramer (1991 to 2008) and Walker and Avant (1995). Analysis of the South African maternal healthcare context uses the open-system theory for sustainability of Olsen and a team of researchers (1998) and several frameworks for healthcare human resources. The main concepts of the model are identified and analysed. The main concepts are Public-Private Partnership, midwifery practice, sustainability and the related concepts are governance, task environment and quality service. The model for a Public-Private Partnership is synthesised through the relation of concepts. The 45 statements of the context empirically ground the study. The model depicts the South African healthcare context and all the factors that impact on midwifery and its context. The model and its functions are explained within a constituted framework. The Global standards for practice of the International Council for Nursing and Midwifery, the definition and core competencies of midwives of the Confederation of Midwives, the Millennium Development Goals for Sub-Sahara Africa 2020 and the newly formed World Health Organisation Partnership for Africa for maternal, newborn and child care 2008 are factors of the global (macro) context that influence the model. The South African healthcare system (meso context) factors include economics, legal-ethical, professional, service delivery and civil society dimensions that impact on policy for service delivery on micro level, where the PPP formally exists. The PPP for maternal healthcare is developed within this framework. The stakeholders of the formal PPP are the public sector, the private sector, the midwifery profession and civil society. The PPP governs the task environment for midwifery through the risk assessment strategies that include financial risk based on clinical risk and the development of norms and standards for staff and resources as expressed in service level agreements for quality service delivery. Governance implies policy standards and the accountability of the PPP to the consumer for service delivery quality and performance. The stakeholders of the PPP ensure sustainability in this model through collaboration and shared responsibility, risk and decision-making between the institution, midwifery profession and practice and civil society for a balance of interest.
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The reasons for choosing a private practising midwife as birth attendant
- Authors: De Maayer, Ivy Lucy
- Date: 2011-11-24
- Subjects: Midwives , Midwifery , Prenatal care , Postnatal care , Childbirth at home
- Type: Thesis
- Identifier: uj:1740 , http://hdl.handle.net/10210/4089
- Description: M.Cur. , Few South African studies have been done with regard to private midwives and their clients. The practices of these midwives are overloaded, indicating a growing need for their services. An exploratory, contextual and descriptive study was undertaken to investigate some of the issues relating to the practice of the private midwife. This was done from the perspective ofthe women attending these practices. The aims of this study were to explore and describe how women experience the care they receive from their private midwives in Gauteng during antenatal visits, labour and postnatal contacts; to explore and describe the reasons for clients of private midwives in Gauteng to choose an independent midwife as birth attendant and to explore how these clients get to hear about their midwives. Eight women, attending a total of two different midwifery practices, were interviewed. The main categories that emerged from analysing the women's experience of private midwifery care were that the midwives were caring, family orientated, informative, knowledgeable, guiding and unintrusive. Time was both respected and given by the midwives. The midwives saw childbirth as a normal and natural process. The midwives empowered the women and left them in control oftheir childbirth. A mutual, intimate relationship was formed between the women and their midwives, which was based on trust and continuity of care. The women felt they were treated as unique individuals. One woman related some negative aspects ofthe care she received. A variety of reasons were given for choosing a private midwife as birth attendant. Some had specific wishes for their birth, such as a homebirth and knew that private midwives would grant them Other reasons included cost effectiveness, control over childbirth, one on one care, shorter waiting periods, longer consulting times and wanting an experienced birth attendant. Previous negative experience with staff at government hospitals and private gynaecologists; and hearing about positive experiences with private midwives also contributed to women opting for independent midwives. The women got to hear about their private midwives through their general practitioner, obstetrician, antenatal class instructor, friends, family members or health professional that delivered a previous baby. These research findings were supported by existing literature and recommendations were made to midwifery practice, education and research.
- Full Text:
- Authors: De Maayer, Ivy Lucy
- Date: 2011-11-24
- Subjects: Midwives , Midwifery , Prenatal care , Postnatal care , Childbirth at home
- Type: Thesis
- Identifier: uj:1740 , http://hdl.handle.net/10210/4089
- Description: M.Cur. , Few South African studies have been done with regard to private midwives and their clients. The practices of these midwives are overloaded, indicating a growing need for their services. An exploratory, contextual and descriptive study was undertaken to investigate some of the issues relating to the practice of the private midwife. This was done from the perspective ofthe women attending these practices. The aims of this study were to explore and describe how women experience the care they receive from their private midwives in Gauteng during antenatal visits, labour and postnatal contacts; to explore and describe the reasons for clients of private midwives in Gauteng to choose an independent midwife as birth attendant and to explore how these clients get to hear about their midwives. Eight women, attending a total of two different midwifery practices, were interviewed. The main categories that emerged from analysing the women's experience of private midwifery care were that the midwives were caring, family orientated, informative, knowledgeable, guiding and unintrusive. Time was both respected and given by the midwives. The midwives saw childbirth as a normal and natural process. The midwives empowered the women and left them in control oftheir childbirth. A mutual, intimate relationship was formed between the women and their midwives, which was based on trust and continuity of care. The women felt they were treated as unique individuals. One woman related some negative aspects ofthe care she received. A variety of reasons were given for choosing a private midwife as birth attendant. Some had specific wishes for their birth, such as a homebirth and knew that private midwives would grant them Other reasons included cost effectiveness, control over childbirth, one on one care, shorter waiting periods, longer consulting times and wanting an experienced birth attendant. Previous negative experience with staff at government hospitals and private gynaecologists; and hearing about positive experiences with private midwives also contributed to women opting for independent midwives. The women got to hear about their private midwives through their general practitioner, obstetrician, antenatal class instructor, friends, family members or health professional that delivered a previous baby. These research findings were supported by existing literature and recommendations were made to midwifery practice, education and research.
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Birth outcomes and client satisfaction of clinically low risk pregnant women in a midwifery-led care service
- Van Heerden, Maria Magdalena
- Authors: Van Heerden, Maria Magdalena
- Date: 2017
- Subjects: Maternal health services - Case studies , Midwifery - Practice , Midwifery , Patient satisfaction
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/273579 , uj:29148
- Description: M.Cur. , Abstract: Background One of South Africa’s leading private healthcare groups launched a midwife-led service, where clinically low risk pregnant women are being seen during the antenatal, labour and postnatal period of pregnancy. This midwife-led care is being rendered from within a maternity ward situated in the acute hospital facility. Due to the huge number of the South African population that do not have medical aid, but still earn an average income above the tax threshold, the private healthcare group is focusing on rendering these services to the clients without medical aid. Since there are very few midwifery-led childbirth practices in the private sector in South Africa, very little is known about the birth outcomes and client satisfaction in these practices. The objectives of this research were to explore and describe birth outcomes and to determine client satisfaction with midwifery-led care. Methods An explorative and descriptive quantitative research design was used to identify and understand the outcomes of midwife-led births and the clients’ satisfaction with the care rendered. The purposive sample of fifty seven women was taken from a population of low risk pregnant women who made use of midwife-led care at the private facility. Data were gathered by utilising a birth outcomes checklist, and a survey to establish client satisfaction. The birth outcomes checklists were completed retrospectively, after the delivery of the baby, by using the clinical records of the client. The surveys on client satisfaction were done on the day of discharge, by means of a short questionnaire being completed by the client. Both tools were checked for reliability and validity. Data from the birth outcomes checklist and the questionnaire were analysed by making use of descriptive statistics. Results The birth outcomes of the low risk pregnant women were recorded in a similar way as the American college of nurse-midwives annual reports for midwives. Measuring was done on low risk birth outcomes such as induction of labour, normal vaginal deliveries (NVD) versus caesarean sections (CS) or if it was an assisted delivery such as a...
- Full Text:
- Authors: Van Heerden, Maria Magdalena
- Date: 2017
- Subjects: Maternal health services - Case studies , Midwifery - Practice , Midwifery , Patient satisfaction
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/273579 , uj:29148
- Description: M.Cur. , Abstract: Background One of South Africa’s leading private healthcare groups launched a midwife-led service, where clinically low risk pregnant women are being seen during the antenatal, labour and postnatal period of pregnancy. This midwife-led care is being rendered from within a maternity ward situated in the acute hospital facility. Due to the huge number of the South African population that do not have medical aid, but still earn an average income above the tax threshold, the private healthcare group is focusing on rendering these services to the clients without medical aid. Since there are very few midwifery-led childbirth practices in the private sector in South Africa, very little is known about the birth outcomes and client satisfaction in these practices. The objectives of this research were to explore and describe birth outcomes and to determine client satisfaction with midwifery-led care. Methods An explorative and descriptive quantitative research design was used to identify and understand the outcomes of midwife-led births and the clients’ satisfaction with the care rendered. The purposive sample of fifty seven women was taken from a population of low risk pregnant women who made use of midwife-led care at the private facility. Data were gathered by utilising a birth outcomes checklist, and a survey to establish client satisfaction. The birth outcomes checklists were completed retrospectively, after the delivery of the baby, by using the clinical records of the client. The surveys on client satisfaction were done on the day of discharge, by means of a short questionnaire being completed by the client. Both tools were checked for reliability and validity. Data from the birth outcomes checklist and the questionnaire were analysed by making use of descriptive statistics. Results The birth outcomes of the low risk pregnant women were recorded in a similar way as the American college of nurse-midwives annual reports for midwives. Measuring was done on low risk birth outcomes such as induction of labour, normal vaginal deliveries (NVD) versus caesarean sections (CS) or if it was an assisted delivery such as a...
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A critical interpretive synthesis of the roles of midwives in health systems
- Mattison, Cristina A., Lavis, John N., Wilson, Michael G., Hutton, Eileen K., Dion, Michelle L.
- Authors: Mattison, Cristina A. , Lavis, John N. , Wilson, Michael G. , Hutton, Eileen K. , Dion, Michelle L.
- Date: 2020
- Subjects: Midwifery , Political systems , Health systems
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/462563 , uj:41250 , Citation: Mattison, C.A. et al. 2020. A critical interpretive synthesis of the roles of midwives in health systems. , DOI: https://doi.org/10.1186/s12961-020-00590-0
- Description: Abstract: Please refer to full text to view abstract.
- Full Text:
- Authors: Mattison, Cristina A. , Lavis, John N. , Wilson, Michael G. , Hutton, Eileen K. , Dion, Michelle L.
- Date: 2020
- Subjects: Midwifery , Political systems , Health systems
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/462563 , uj:41250 , Citation: Mattison, C.A. et al. 2020. A critical interpretive synthesis of the roles of midwives in health systems. , DOI: https://doi.org/10.1186/s12961-020-00590-0
- Description: Abstract: Please refer to full text to view abstract.
- Full Text:
Understanding the conditions that influence the roles of midwives in Ontario, Canada’s health system: an embedded single-case study
- Mattison, Cristina A., Lavis, John N., Hutton, Eileen K., Dion, Michelle L., Wilson, Michael G.
- Authors: Mattison, Cristina A. , Lavis, John N. , Hutton, Eileen K. , Dion, Michelle L. , Wilson, Michael G.
- Date: 2020
- Subjects: Midwifery , Case study , Political systems
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/462266 , uj:41213 , Citation: Mattison, C.A. et al. 2020. Understanding the conditions that influence the roles of midwives in Ontario, Canada’s health system: an embedded single-case study. , DOI: 10.1186/s12913-020-5033-x
- Description: Abstract: Background: Despite the significant variability in the role and integration of midwifery across provincial and territorial health systems, there has been limited scholarly inquiry into whether, how and under what conditions midwifery has been assigned roles and integrated into Canada’s health systems. Methods: We use Yin’s (2014) embedded single-case study design, which allows for an in-depth exploration to qualitatively assess how, since the regulation of midwives in 1994, the Ontario health system has assigned roles to and integrated midwives as a service delivery option. Kingdon’s agenda setting and 3i + E theoretical frameworks are used to analyze two recent key policy directions (decision to fund freestanding midwifery-led birth centres and the Patients First primary care reform) that presented opportunities for the integration of midwives into the health system. Data were collected from key informant interviews and documents. Results: Nineteen key informant interviews were conducted, and 50 documents were reviewed in addition to field notes taken during the interviews. Our findings suggest that while midwifery was created as a self-regulated profession in 1994, health-system transformation initiatives have restricted the profession’s integration into Ontario’s health system. The policy legacies of how past decisions influence the decisions possible today have the most explanatory power to understand why midwives have had limited integration into interprofessional maternity care. The most important policy legacies to emerge from the analyses were related to payment mechanisms. In the medical model, payment mechanisms privilege physician-provided and hospital-based services, while payment mechanisms in the midwifery model have imposed unintended restrictions on the profession’s ability to practice in interprofessional environments. Conclusions: This is the first study to explain why midwives have not been fully integrated into the Ontario health system, as well as the limitations placed on their roles and scope of practice. The study also builds a theoretical understanding of the integration process of healthcare professions within health systems and how policy legacies shape service delivery options.
- Full Text:
- Authors: Mattison, Cristina A. , Lavis, John N. , Hutton, Eileen K. , Dion, Michelle L. , Wilson, Michael G.
- Date: 2020
- Subjects: Midwifery , Case study , Political systems
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/10210/462266 , uj:41213 , Citation: Mattison, C.A. et al. 2020. Understanding the conditions that influence the roles of midwives in Ontario, Canada’s health system: an embedded single-case study. , DOI: 10.1186/s12913-020-5033-x
- Description: Abstract: Background: Despite the significant variability in the role and integration of midwifery across provincial and territorial health systems, there has been limited scholarly inquiry into whether, how and under what conditions midwifery has been assigned roles and integrated into Canada’s health systems. Methods: We use Yin’s (2014) embedded single-case study design, which allows for an in-depth exploration to qualitatively assess how, since the regulation of midwives in 1994, the Ontario health system has assigned roles to and integrated midwives as a service delivery option. Kingdon’s agenda setting and 3i + E theoretical frameworks are used to analyze two recent key policy directions (decision to fund freestanding midwifery-led birth centres and the Patients First primary care reform) that presented opportunities for the integration of midwives into the health system. Data were collected from key informant interviews and documents. Results: Nineteen key informant interviews were conducted, and 50 documents were reviewed in addition to field notes taken during the interviews. Our findings suggest that while midwifery was created as a self-regulated profession in 1994, health-system transformation initiatives have restricted the profession’s integration into Ontario’s health system. The policy legacies of how past decisions influence the decisions possible today have the most explanatory power to understand why midwives have had limited integration into interprofessional maternity care. The most important policy legacies to emerge from the analyses were related to payment mechanisms. In the medical model, payment mechanisms privilege physician-provided and hospital-based services, while payment mechanisms in the midwifery model have imposed unintended restrictions on the profession’s ability to practice in interprofessional environments. Conclusions: This is the first study to explain why midwives have not been fully integrated into the Ontario health system, as well as the limitations placed on their roles and scope of practice. The study also builds a theoretical understanding of the integration process of healthcare professions within health systems and how policy legacies shape service delivery options.
- Full Text:
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