The Ontario
Midwifery Program
Program Evaluation Proposal
Summer 2002

OMP Program Overview

What the Literature Shows

Description of Evaluation Proposal

Questions (and a Few Answers)
Agenda
Overview
Literature
Proposed
Evaluation
Questions
OMP Program
Overview
History
Overview

Literature
Midwifery became regulated in
Ontario in 1994

Proposed
Evaluation


Questions
Midwifery care existed previously but
wasn’t covered by OHIP
The Ontario Midwifery Program
was formed as a result
Other provinces followed suit by
regulating midwifery services
Midwifery Service
Components
Overview

Literature


Midwifery Education
Midwifery Practice
Midwifery Research

Proposed
Evaluation
Questions
The current study is limited in scope to
midwifery practice only
Program
Components
Overview

Literature


Proposed
Evaluation
Questions


Education/Prevention
Pre-natal care
Labour/Birth care
Post-partum care
Counseling/Support
Overview
Literature
Proposed
Evaluation
Questions
Overview
Literature
Proposed
Evaluation
Questions
What the
Literature Shows
In General
Overview

Literature

Proposed
Evaluation
Questions
No studies found evaluating
funding formula/method/process
Some cost-effectiveness
studies


Focused more on outcomes however
Showed some improved outcomes for
midwifery over obstetrics
Quebec Pilot
Overview

Literature


Proposed
Evaluation


Questions
Multi-faceted evaluation
“Set up for failure”, but also for
success
Lots of opposition to midwifery
services in Quebec
Midwifery regulation was adopted in the
end however
Outcome measures showed
positive improvements over
obstetric care
Overview
Literature
Proposed
Evaluation
Questions
Description of
Evaluation
Proposal
Two Parts
Overview

Process Evaluation:

Literature

Outcome Evaluation:

Proposed
Evaluation
Questions
Funding methods and effectiveness
Economic cost-effectiveness analysis
Design
Overview

Literature

Proposed
Evaluation
Questions

Comparative data analysis
approach
Economic cost-effectiveness
analysis will also be used
The sample population consists
of low-risk pregnant women
receiving maternity care in
2000, 2001, and 2002 in
Ontario, Canada
Overview
Outcome Measures

Literature


Proposed
Evaluation


Questions

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Number of prenatal visits per
client
Epidural use during labour
Use of delivery aid devices
Caesarean section required
Episiotomy required
Resuscitation required
Length of hospital stay
Limitations
Overview

Literature

Proposed
Evaluation


Questions
The client viewpoint is used rather
than the preferred societal
viewpoint.
The use of TPAs is a recent
addition to the OMP and therefore
data availability may be limited.
A cost-effectiveness analysis
doesn’t give as complete a picture.
Comparing obstetric care data to
midwifery care data may be
inherently difficult.
Overview
Literature
Proposed
Evaluation
Questions
Questions?