{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:25:33Z","timestamp":1787955933132,"version":"build-2784847793"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,3,3]],"date-time":"2014-03-03T00:00:00Z","timestamp":1393804800000},"content-version":"vor","delay-in-days":61,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Midwifery has been regulated and publicly funded in British Columbia since 1998. Midwives are currently concentrated in urban areas; access to care is limited in rural communities. Rural midwifery practice can be challenging because of low birth numbers, solo practice, lack of on\u2010site cesareans and specialist backup, and interprofessional tensions resulting from the integration of midwives into rural maternity care systems. Despite these barriers, rural midwives have made a substantial contribution to rural maternity care in British Columbia. The purpose of this retrospective cohort study is to examine outcomes of midwife\u2010involved births in rural British Columbia in the postregionalization era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed the outcomes of all parturient women with postal codes outside of the core urban areas of the province, and their singleton infants without a diagnosed congenital anomaly, who had a midwife involved in their care between April 1, 2003, and March 31, 2008. Outcomes are reported for 6 obstetric service levels. Service levels are assigned to parturient women via maternal postal codes. Women who reside further than 60\u00a0minutes from a hospital with maternity services were assigned a distance category (2 levels: &gt;2 hours, 1\u20102 hours); women residing within one hour of a hospital with maternity services were assigned the level of service available at their catchment hospital (4 levels, ranging from maternity care without cesarean to cesarean provided by general surgeons or obstetricians).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight percent of rural parturient women had a midwife involved in their care. Rates of planned home birth exceeded the provincial average (26.1%) in 5 of the 6 service levels. Rates of actual home birth were lowest among women who resided 2 or more hours away from maternity services. Obstetric intervention rates were lower for women residing in communities without cesareans or with intermittent access to cesareans. The prevalence of adverse neonatal outcomes was very low across service levels; perinatal mortality was elevated among women residing in communities more than 2 hours away from services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Despite numerous challenges, midwives provide safe maternity care to rural parturient women and offer choice of birth place. Given the difficulty of recruiting and retaining maternity care providers to rural settings in British Columbia and across Canada, these findings open the door for a more sustained planning process involving midwives in rural communities. Reasons for the elevated perinatal mortality rate among women who live more than 2 hours away from services should be explored in more detail, perhaps via in\u2010depth interviews with rural midwives who serve this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jmwh.12137","type":"journal-article","created":{"date-parts":[[2014,3,3]],"date-time":"2014-03-03T14:09:34Z","timestamp":1393855774000},"page":"60-66","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Midwifery Care in Rural and Remote British Columbia: A Retrospective Cohort Study of Perinatal Outcomes of Rural Parturient Women With a Midwife Involved in Their Care, 2003 to 2008"],"prefix":"10.1111","volume":"59","author":[{"given":"Kathrin","family":"Stoll","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jude","family":"Kornelsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,3,3]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Report on the Findings of a Consensus Conference on Obstetrical Services in Rural and Remote Communities","author":"British Columbia Reproductive Care Program","year":"2002"},{"issue":"3","key":"e_1_2_8_3_1","first-page":"218","article-title":"Podium: Doctors speak out. Is local maternity care sustainable without general practitioner surgeons?","volume":"11","author":"Kornelsen J","year":"2006","journal-title":"Can J Rural Med"},{"key":"e_1_2_8_4_1","unstructured":"College of Midwives of British Columbia.Register of current and former registrants. Available at:http:\/\/www.cmbc.bc.ca\/pdf.shtml?List\u2010of\u2010Registrants. Accessed December 7 2012."},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1258\/135581905774424528"},{"key":"e_1_2_8_6_1","unstructured":"Society of Rural Physicians of Canada.National Rural Health Strategy. Available at:http:\/\/www.srpc.ca\/PDF\/nrhsB.pdf. Accessed July 1 2013."},{"key":"e_1_2_8_7_1","first-page":"101","volume-title":"A Review of Performance Agreements Between the Ministry of Health Services and Health Authorities","author":"Office of the Auditor General of British Columbia","year":"2003"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.109-3166"},{"issue":"1","key":"e_1_2_8_9_1","first-page":"7","article-title":"You don't know what you've got till it's gone\u201d: The role of maternity care in community sustainability","volume":"16","author":"Miewald C","year":"2011","journal-title":"Canadian Journal of Rural Medicine"},{"issue":"147","key":"e_1_2_8_10_1","first-page":"1","article-title":"Distance matters: A population based study examining access to maternity services for rural women","volume":"11","author":"Grzybowski S","year":"2011","journal-title":"BMC Health Serv Res"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2010.00332.x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3138\/cbmh.17.1.73"},{"issue":"2","key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.22374\/cjmrp.v9i2.128","article-title":"Maternity nurses and midwives in a British Columbia rural community: Evolving relationships","volume":"9","author":"Bell I","year":"2010","journal-title":"Can J Midwifery Res Prac"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2012.06.004"},{"key":"e_1_2_8_15_1","unstructured":"Centre for Rural Health Research the Rural and Remote Midwifery Committee.Proceedings from the 3rd invitational rural midwifery symposium;2011Apr 26\u201027;Vancouver BC."},{"issue":"3","key":"e_1_2_8_16_1","first-page":"315","article-title":"Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia","volume":"166","author":"Janssen PA","year":"2002","journal-title":"Can Med Assoc J"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.081869"},{"key":"e_1_2_8_18_1","volume-title":"Special Report: Midwifery in British Columbia","author":"British Columbia Perinatal Health Program","year":"2008"},{"key":"e_1_2_8_19_1","volume-title":"Annual Perinatal Health Report: 2008","author":"British Columbia Perinatal Health Program","year":"2010"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1584.2010.01170.x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.1996.tb00477.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0091-2182(93)90123-X"},{"key":"e_1_2_8_23_1","unstructured":"ACNM Benchmarking Project: 2011 Results Summary. 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