Ontario Midwifery ProgramMinistry of Health and Long-Term Care

Ontario Midwifery Clinical DatabaseAPHEO Conference

October 16 to 17, 2006

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Midwifery in Ontario – History

• In 1994, Ontario was the first province to regulate the midwifery profession and to fund midwifery services as part of its provincial healthcare system. Since 1994, British Columbia, Alberta, Saskatchewan, Manitoba and Quebec have regulated the profession. Nova Scotia, New Brunswick and Newfoundland have regulation plans in development.

• Midwifery care in Ontario is based upon a regulated model and scope of practice governed by the College of Midwives of Ontario. In addition to clinical standards and regulations, themidwifery models is based upon three main principles: Continuity of Care, Choice of Birthplace and Informed Choice.

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Midwifery in Ontario – History con’t

• Midwives work in practice groups, similar to groups of family practice doctors, and are engaged by contract to community health care agencies called transfer payment agencies (TPA). There are 63 practice groups in Ontario.

• Trends indicate that 380 registered midwives in Ontario will attend approximately 8% of Ontario's births in 2006-07. About 80% of births are projected to take place in Ontario hospitals and 20% are projected take place at home. Midwifery services are offered at approximately 2/3 of Ontario birthing hospitals (approx 64 hospitals).

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Midwifery Data – History • Program framework included evaluation as a component but no

database was established in conjunction with the funding program. • Being the first province to regulate midwifery, there were no

comparable extra-provincial data holdings• Professional association (AOM) initiated data collection process but

voluntary nature prevented reliable data for sensitive indicators • Ministry studied feasibility of comprehensive data system with multi-

stakeholder participation• April 2003 – retirement of AOM system and initiation of mandatory

ministry system of manual entry and validation of clinical/financial/utilization data

• August 2005 – web-based access to data via a reporting and analysis tool (Metrics3D)

• September 2006 – online data entry and processing• October 2006 – 3 full years of data available to stakeholders

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Midwifery Data Elements• Midwifery data elements selected in consultation with stakeholders• Examples of April 2003 includes data on:

• # of pre and postnatal visits• Gestational age at care intake and at birth• Mode of birth• Birth setting and location• Induction and augmentation• Pharmaceutical use• Blood loss• Length of hospital stay• Birth weight and Apgars• Infant anomalies• NICU admissions• Breastfeeding duration

• April 2006 data elements modified to be in line with other provincial perinatal databases

Midwifery Data Entry

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Midwifery Data Reporting

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Midwifery and Data - Then

• For 2003 Program Evaluation data was pulled from a variety of different sources - medical/institutional programs, human resources databases, OHIP, DAD

• Lack of comparable Ontario data – solution was to create low-risk cohort data set (perinatal outcomes of prenatal clients in the care of family physicians practising obstetrics) from OHIP database

• Available data limited to poorly matched international studies

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Data Element

OntarioMidwifery

Program Evaluation 2001-02

Low-Risk Cohort 2001-02

Other study ExamplesPHRED StudyOttawa 2000-01CPSS 1997-98

% Infants Breastfed 1st week 97.2 88.6

% Infants Breastfed 6th week 90.7 71.5

% C-Section Births 12.7 20.6 19.6

% C-Sec Primary 11.1 13.8

% Live Instrumental Births 5.4 14.4 17.2

% Live Forceps Births 2.6 4.9 7.4

% Live Vacuum Births 3 9.5 10.5

% Perineal Trauma 55.9 43.9

% Episiotomy 7.2 16.6 25.4

% Laceration 1st/2nd 47.8 41.2 48.8

% Laceration 3rd/4th 2.2 2.7 3.9

Fetal Mortality Rate 3 4.7

Neonatal Mortality Rate 4 3.3 3.9

% Vaginal Birth LOS 0-24 hours 74.2 2.4

% Vaginal Birth LOS 25-60 hours 32.2 25.6

% C-Section LOS 60 hours 45.9 31.3

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Midwifery and Data - Now

• Comprehensive data set collected since April 2003• Data on 100% of women who receive midwifery services are

recorded• Data validated and cleaned• 3 completed years of data available for comparative reporting• Greater collaboration with other perinatal data sets including

Niday and its regional partners

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Data Element

OntarioMidwiferyProgram2003-04

OntarioMidwifery

Program2004-05

PPPESOAnnual Report2005-06

GTA CHNAnnual Report2005-06

% Infants Breastfed 1st week 97 97.3 87.1 (intention) 89 (intention)

% Infants Breastfedmilk 6th week 87.2 91.7

% C-Section Births 14.5 15.6 28.3 28.6

% C-Sec Primary 80.8 79.9

% Live Instrumental Births 5.5 4.8 13 16

% Live Forceps Births 2.6 2.2 3.3 4

% Live Vacuum Births 3.1 3 10.7 11.2

Fetal Mortality Rate 6.2 5.1 5.8 6

Neonatal Mortality Rate 2.1 2

% Vaginal Birth LOS 0-24 hours 49.6 52

% Vaginal Birth LOS 25-60 hours 24 25.3

% C-Section LOS 60 hours 49.1 45

# of Births Hospital 5813 6668

# of Births Home 1919 1844

# of Births Other Location 30 35

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Midwifery and Data – NextPriority #1 A single provincial data set for all perinatal clinical outcomes that will be comparable nationally (Niday + Midwifery)

17Midwifery and Maternal Newborn Data Next Steps

• Creating comparable datasets among not only perinatal but also wider maternal newborn health care programs including:

• Public Health• Chronic Disease • Infant Care• Mental Health• Transport• Fetal Surveillance• Health Human Resources • Costing

• Ability to do greater analysis on models of service delivery and outcomes• Longitudinal population health analysis

Questions?