title: Midwifery in a new context: expanding our reference points and embracing new representations of pregnancy and birth.
abstract: OBJECTIVE
  To learn the adaptations and transformations that midwives from abroad must go through in order to integrate into the practice of Quebec midwifery, which is founded on a concept of birth akin to the holistic model.
  
  
  METHODS
  Qualitative research achieved through semi-structured interviews with an ethnological approach for data collection and analysis.
  
  
  METHODS
  Quebec, Canada.
  
  
  METHODS
  11 immigrant midwives practising in Quebec. Interviews were also conducted with midwives from Quebec trained abroad (3) and trained in Quebec (5).
  
  
  RESULTS
  The greatest challenge for most of the midwives interviewed has been the change of professional culture. Shifting from a technocratic or medical practice model towards a holistic practice model has expanded their points of reference. Medical knowledge has become a type of shared knowledge, with each contributor judged equally important. Nature and humanity now prevail over technology. The woman has become the primary reference source for decision-making. For some midwives of foreign origin, integration into the Quebec practice provided an opportunity to reflect upon or modify their perception of pregnancy. In terms of representations, although most of the midwives interviewed now consider childbirth a life-affirming experience; for others, it represents a potential risk of complications or catastrophes. This apprehensiveness is more significant among midwives who have been trained in a medical model and who come from a country where the medical culture is socially dominant.
  
  
  CONCLUSIONS
  Midwives from highly medicalized environments face a greater adjustment when integrating into Quebec's practice culture. They must shift from a 'risk' mindset to a 'confidence' mindset and develop their trust in the normal process of pregnancy and childbirth. They must acquire a sense of inner security on which they can rely instead of systematically resorting to technological referents. This adjustment of referents and representations is an operative transformation process that is often accompanied by changes in identity.
  
  
  CONCLUSIONS
  To facilitate the integration of immigrant midwives, it is important to consider the professional culture changes they face. If they are to use a holistic practice model, they must engage in introspection. They must reflect on pregnancy and childbirth if they are to consider these events first and foremost as a healthy, integral part of women's lives.
authors.affiliation: Programme en pratique sage-femme, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, Québec, Canada G9A 5H7. Raymonde.gagnon@uqtr.ca
authors.forename: Raymonde
authors.initials: R
authors.lastname: Gagnon
mesh_terms: D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008880:Midwifery / Q000379:methods*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D057184:Practice Patterns, Nurses'; D011247:Pregnancy; D017009:Professional Autonomy; D011792:Quebec; D012938:Social Perception