Does Midwifery Care Reduce Adverse Infant Birth Outcomes for Women with Low Socioeconomic Position Compared to Care Received from Obstetricians or Family Practitioners?
1. (a) Is there an association between midwifery care and reduced adverse infant birth outcomes compared to physician or obstetrician-led care for women with low socioeconomic position SEP and low medical and obstetric risk? The underlying hypothesis for this objective is that the depth, quality, and continuity of relationship between a midwife and client exceeds that of other clinician-patient relationships, thereby providing extra psychosocial and educational support that can impact birth outcomes for vulnerable women.
1. (b) If a significant association exists, what is the provincial population attributable risk (PAR) of SGA births and regional PARs for each Health Service Delivery Area in B.C.? Understanding the magnitude of risk-reduction attributable to midwifery care and if and how region of residence impacts risk for this population provides useful information for tailoring practice and policy to identified need.
2. Is there is a statistically significant difference between rates of adverse infant birth outcomes for midwifery clients with low SEP compared to those with high SEP? This comparative analysis will help in interpreting birth outcome equity among midwifery clients and delineate the limitations of perinatal care provision in deconstructing health inequity.
3. Is there a difference in risk of adverse infant outcomes for women in the care of midwives, compared to physicians or obstetricians, who are experiencing occasional versus long-term low SEP? Because income status is dynamic, this analysis will capture a more nuanced understanding of the health impacts of enduring low income and low socioeconomic position compared to less entrenched low SEP.