Primary birthing attendants and birth outcomes in remote Inuit communities - a natural "experiment" in Nunavik, Canada

• Published in: Journal of Epidemiology & Community Health
• Main Authors: Simonet, Fabienne, Wilkins, Russell, Labranche, Elena, Smylie, Janet, Heaman, Maureen, Martens, Patricia, Fraser, William D, Minich, Katherine, Wu, Yuquan, Carry, Catherine, Luo, Zhong-Cheng
• Format: Text
• Language: English
• Published: BMJ Publishing Group Ltd 2009
• Subjects: Research reports; Hudson Bay; Nunavik; Canada; Hudson; Ungava Bay; inuit
• Online Access: http://jech.bmj.com/cgi/content/short/jech.2008.080598v1; https://doi.org/10.1136/jech.2008.080598

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", we assessed birth outcomes 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 (1,529 Inuit births) versus Western physicians in Ungava Bay communities (1,197 Inuit births). The primary outcome was perinatal death. Secondary outcomes included stillbirth, neonatal death, postneonatal death, preterm, small-for-gestational-age and low birth weight birth. Multi-level 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 aOR (95% confidence interval) for perinatal death comparing the Hudson Bay versus Ungava Bay communities were 1.29 (0.63, 2.64) for all Inuit births, and 1.13 (0.48, 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 as compared to the Ungava Bay communities with physician-led maternity care. Our 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.