| Summary: | Introduction: In northern Canada women residing in rural communities without local access to maternity care must evacuate at 36-37 weeks gestation to await labour in a city with a regional hospital. Midwifery services are expanding to rural areas of Canada, yet there are few studies that evaluate the safety of rural and remote midwifery compared to routine evacuation for birth. The purpose of this study is to assess the safety of the Fort Smith Midwifery Program in the Northwest Territories, and to understand the experiences of, and the meaning of, community birth with midwives among the women of Fort Smith. Methods: A retrospective cohort study was conducted to compare birth outcomes from the Fort Smith Midwifery Program (n=281) to: 1) the Inuulitsivik Midwifery Program in northern Quebec (n=1388), and 2) the community of Hay River where women evacuate at 37 weeks to receive intrapartum care elsewhere (n=143). Maternal and newborn outcomes were compared among the three comparison groups using univariate and multivariate logistic regression. Focus groups were held with women from Fort Smith who had used the midwifery program to understand their experiences of using the midwifery service and what it means to have access to community birth. Purposive sampling was used to invite Aboriginal and non-Aboriginal participants who gave birth in the community and elsewhere. Results: There were no statistically significant differences in the odds of 5-minute APGAR scores less than 7. The odds of 1-minute APGAR scores below 7 in Fort Smith were increased compared to the Hudson coast communities, however the rate was similar to those of newborns of women who reside in Hay River and delivered in Yellowknife. Two themes emerged from the focus groups: 1) the midwifery model of care in the community leads to positive experiences of maternity care, and 2) the benefits of and reasons for giving birth in the community. Women spoke positively about their experiences of using the midwifery service whether or not they delivered in the community. Discussion: The findings of this thesis support the development and evaluation of midwife-led models of maternity care in rural and remote communities.
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