Table 1 Factors that affect government agenda setting and the decision to fund freestanding midwifery-led birth centres

Problems

Rising rates of medical interventions and associated increases in healthcare costs

• Increasing rates of non-medical caesareans and induction practices

Hospital barriers to midwifery practice

• Capping the number of midwives who have hospital privileges and the number of births attended by midwives

• Restrictions to scope of practice (e.g., transfer of care criteria to an obstetrician for inductions and epidurals)

KIs [35,36,37];

KIs [38, 39];

Policies

Birth centre proposals and plans already existed

• Original birth centre proposals and plans were available from the 1990s, which midwives were able to draw from

Supportive evidence

• Evidence on midwifery-led birth centre outcomes for low-risk pregnant woman in other jurisdictions in Canada (e.g., Quebec, Alberta and Manitoba)

KIs [40, 41];

KIs [42,43,44];

Politics

Change in government

• Two original freestanding birth centres (located in St. Jacobs and Toronto) were created in the 1990s but were shelved just before doors opened due to change in government (Conservative government led by Mike Harris) when the call went out for the new birth centres, midwives were able to draw from the original applications

KIs [41];

Participants

Visible

• Heavy lobbying from the then president of the Association of Ontario Midwives, which had resources to campaign (e.g., posters and blogs)

• Deb Matthews, Minister of Health and Long-Term Care, was supportive of midwifery and daughter used midwives

• Premier Kathleen Wynne was supportive of midwifery and used midwives for both births (in the Netherlands)

Hidden

• Consumers sent 10,000 electronic postcards to their MPPs, promoted birth centres on social media and at special events to promote

• Midwives meeting with their local MPPs

KIs [21, 45,46,47,48,49,50];

KIs [51];