Continuity of Care and Shared Decision-Making in Interprofessional Collaborative Maternity Practices in Canada

Problem: The number of maternity care providers varies across Canada. Women from rural communities or those marginalized due to physical, psychological or social issues including newcomers, often experience challenges accessing health care (Fraser Health, 2014; Rogers, 2003). Interprofessional collaborative maternity care [IPCMC] has been credited as a means of increasing access and promoting sustainability of services (Miller et al., 2012; Society of Obstetricians and Gynecologists of Canada, 2008). Midwifery could play a greater role in delivery of services through IPCMC. However, little is known about collaboration in these practices. The purposes of this study are to explore factors influencing enactment of IPCMC and understand whether and how midwives can provide relational care in these practices in ways that are positively evaluated by women and staff. Method: A qualitative multiple case study design was used to explore variations in 4 IPCMC practices in British Columbia, Canada. Sources of data included: observation and semi-structured interviews with staff (n=40) and women receiving care (n=33). Thematic analysis was applied to interview transcripts, observational field notes and analytic notes. Findings and Conclusions: Collaborative care was well received by patients when expectations were clear and continuity of information and philosophy were exercised. Contextual factors influenced development and implementation requiring adaptation over time. Communication, organization, mutual respect and commitment enabled collaboration and relational care. Policy changes to promote and sustain IPCMC include broader definitions of continuity of care; increased support and adoption of integrated funding models. Interprofessional education is needed to develop skills for effective collaboration