Primary birthing attendants and birth outcomes in remote Inuit communities--a natural "experiment" in Nunavik, Canada
Background: There is a lack of data on the safety of midwife-led maternity care in remote or indigenous communities. In a de facto natural “experiment”, birth outcomes were assessed by primary birthing attendant in two sets of remote Inuit communities. Methods: A geocoding-based retrospective birth...
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fthighwire:oai:open-archive.highwire.org:jech:63/7/546 2023-05-15T16:35:19+02:00 Primary birthing attendants and birth outcomes in remote Inuit communities--a natural "experiment" in Nunavik, Canada Simonet, F Wilkins, R Labranche, E Smylie, J Heaman, M Martens, P Fraser, W D Minich, K Wu, Y Carry, C Luo, Z-C 2009-07-01 00:00:00.0 text/html http://jech.bmj.com/cgi/content/short/63/7/546 https://doi.org/10.1136/jech.2008.080598 en eng BMJ Publishing Group Ltd http://jech.bmj.com/cgi/content/short/63/7/546 http://dx.doi.org/10.1136/jech.2008.080598 Copyright (C) 2009, BMJ Publishing Group Ltd Research reports TEXT 2009 fthighwire https://doi.org/10.1136/jech.2008.080598 2013-05-27T01:11:18Z Background: There is a lack of data on the safety of midwife-led maternity care in remote or indigenous communities. In a de facto natural “experiment”, birth outcomes were assessed by primary birthing attendant in two sets of remote Inuit communities. Methods: A geocoding-based retrospective birth cohort study in 14 Inuit communities of Nunavik, Canada, 1989–2000: primary birth attendants were Inuit midwives in the Hudson Bay (1529 Inuit births) vs western physicians in Ungava Bay communities (1197 Inuit births). The primary outcome was perinatal death. Secondary outcomes included stillbirth, neonatal death, post-neonatal death, preterm, small-for-gestational-age and low birthweight birth. Multilevel logistic regression was used to obtain the adjusted odds ratios (aOR) controlling for maternal age, marital status, parity, education, infant sex and plurality, community size and community-level random effects. Results: The aORs (95% confidence interval) for perinatal death comparing the Hudson Bay vs Ungava Bay communities were 1.29 (0.63 to 2.64) for all Inuit births and 1.13 (0.48 to 2.47) for Inuit births at ⩾28 weeks of gestation. There were no statistically significant differences in the crude or adjusted risks of any of the outcomes examined. Conclusion: Risks of perinatal death were somewhat but not significantly higher in the Hudson Bay communities with midwife-led maternity care compared with the Ungava Bay communities with physician-led maternity care. These findings are inconclusive, although the results excluding extremely preterm births are more reassuring concerning the safety of midwife-led maternity care in remote indigenous communities. Text Hudson Bay inuit Ungava Bay Nunavik HighWire Press (Stanford University) Hudson Bay Nunavik Canada Hudson Ungava Bay ENVELOPE(-67.489,-67.489,59.498,59.498) Journal of Epidemiology & Community Health 63 7 546 551 |
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Research reports Simonet, F Wilkins, R Labranche, E Smylie, J Heaman, M Martens, P Fraser, W D Minich, K Wu, Y Carry, C Luo, Z-C Primary birthing attendants and birth outcomes in remote Inuit communities--a natural "experiment" in Nunavik, Canada |
topic_facet |
Research reports |
description |
Background: There is a lack of data on the safety of midwife-led maternity care in remote or indigenous communities. In a de facto natural “experiment”, birth outcomes were assessed by primary birthing attendant in two sets of remote Inuit communities. Methods: A geocoding-based retrospective birth cohort study in 14 Inuit communities of Nunavik, Canada, 1989–2000: primary birth attendants were Inuit midwives in the Hudson Bay (1529 Inuit births) vs western physicians in Ungava Bay communities (1197 Inuit births). The primary outcome was perinatal death. Secondary outcomes included stillbirth, neonatal death, post-neonatal death, preterm, small-for-gestational-age and low birthweight birth. Multilevel logistic regression was used to obtain the adjusted odds ratios (aOR) controlling for maternal age, marital status, parity, education, infant sex and plurality, community size and community-level random effects. Results: The aORs (95% confidence interval) for perinatal death comparing the Hudson Bay vs Ungava Bay communities were 1.29 (0.63 to 2.64) for all Inuit births and 1.13 (0.48 to 2.47) for Inuit births at ⩾28 weeks of gestation. There were no statistically significant differences in the crude or adjusted risks of any of the outcomes examined. Conclusion: Risks of perinatal death were somewhat but not significantly higher in the Hudson Bay communities with midwife-led maternity care compared with the Ungava Bay communities with physician-led maternity care. These findings are inconclusive, although the results excluding extremely preterm births are more reassuring concerning the safety of midwife-led maternity care in remote indigenous communities. |
format |
Text |
author |
Simonet, F Wilkins, R Labranche, E Smylie, J Heaman, M Martens, P Fraser, W D Minich, K Wu, Y Carry, C Luo, Z-C |
author_facet |
Simonet, F Wilkins, R Labranche, E Smylie, J Heaman, M Martens, P Fraser, W D Minich, K Wu, Y Carry, C Luo, Z-C |
author_sort |
Simonet, F |
title |
Primary birthing attendants and birth outcomes in remote Inuit communities--a natural "experiment" in Nunavik, Canada |
title_short |
Primary birthing attendants and birth outcomes in remote Inuit communities--a natural "experiment" in Nunavik, Canada |
title_full |
Primary birthing attendants and birth outcomes in remote Inuit communities--a natural "experiment" in Nunavik, Canada |
title_fullStr |
Primary birthing attendants and birth outcomes in remote Inuit communities--a natural "experiment" in Nunavik, Canada |
title_full_unstemmed |
Primary birthing attendants and birth outcomes in remote Inuit communities--a natural "experiment" in Nunavik, Canada |
title_sort |
primary birthing attendants and birth outcomes in remote inuit communities--a natural "experiment" in nunavik, canada |
publisher |
BMJ Publishing Group Ltd |
publishDate |
2009 |
url |
http://jech.bmj.com/cgi/content/short/63/7/546 https://doi.org/10.1136/jech.2008.080598 |
long_lat |
ENVELOPE(-67.489,-67.489,59.498,59.498) |
geographic |
Hudson Bay Nunavik Canada Hudson Ungava Bay |
geographic_facet |
Hudson Bay Nunavik Canada Hudson Ungava Bay |
genre |
Hudson Bay inuit Ungava Bay Nunavik |
genre_facet |
Hudson Bay inuit Ungava Bay Nunavik |
op_relation |
http://jech.bmj.com/cgi/content/short/63/7/546 http://dx.doi.org/10.1136/jech.2008.080598 |
op_rights |
Copyright (C) 2009, BMJ Publishing Group Ltd |
op_doi |
https://doi.org/10.1136/jech.2008.080598 |
container_title |
Journal of Epidemiology & Community Health |
container_volume |
63 |
container_issue |
7 |
container_start_page |
546 |
op_container_end_page |
551 |
_version_ |
1766025538988670976 |