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More
Than 1 in 5 Canadian Babies Now Delivered by C-Section
Fewer family doctors delivering babies
(April 21, 2004) —Canada's caesarean section rate
reached an all-time high of 22.5% of in-hospital deliveries in
2001–2002, according to a new report by the Canadian Institute
for Health Information (CIHI). This trend coincides with a decline
in
the number of family doctors providing full maternity care. Fewer
than
19% of family physicians billed for obstetrical services in
1999—compared with just over 31% in 1989.
Giving Birth in Canada:
Providers of Maternity and Infant Care, the
first document of a four-part series on giving birth in Canada to
be
published this year, shows that while most family physicians still
provide some maternity care, fewer are delivering babies than in
the
past. In addition, they are less likely to deliver multiple births
or
perform caesarean sections. In 2000, obstetricians attended 61%
of
vaginal births and 95% of all caesarean births—up from 56% and
93% in 1996, respectively. Of those obstetricians who attended births,
the majority (64%) attended between 101 and 300 in 1999. Family
physicians who attended births attended 41 on average in 2000. The
proportion of family physicians attending deliveries ranged from
8% to
69%, depending on the province or territory. Family physicians in
the
western provinces and the territories are more likely to deliver
babies than those in central or Atlantic Canada, and small town/rural
area family doctors are more likely to attend deliveries than their urban
counterparts: 27% reported delivering babies in 2001, compared with 12%
in urban areas.
“Family doctors entering practice may believe
that maternity
care will add more stress to their already busy lives,”
explains Dr. Elizabeth Whynot, President of the British Columbia
Women's Hospital and Health Centre. “Research on new
family doctors suggests that confidence in obstetrical skills, fee
structures, and fear of malpractice suits are all factors that inhibit
them from choosing to deliver babies as part of their
practice.”
The report also shows that while 34% of
obstetricians/gynaecologists were planning to retire between 1999 and 2004,
about 250 are projected to have entered residency programs in this field
over the same time period. In 2002, Ontario had the highest rate of
obstetricians/gynaecologists, with six per 100,000. Newfoundland
and
Labrador, Prince Edward Island, New Brunswick, Saskatchewan and
Alberta all had the lowest, with four per 100,000.
This report raises questions about who
will be supporting mothers and
delivering their babies in the future,” says Dr. Whynot. “By understanding
the evolving trends, health planners may be
better equipped to find new ways to broaden support for a full
spectrum of maternity care—from obstetricians and family
doctors to midwives, nurses and nurse practitioners."
More Report Findings
Canada's overall birth rate dropped from 14.5 per 1,000 in
1990–1991 to 10.5 per 1,000 in 2000–2001.
Canadian mothers are getting older. In
1991, 34% of babies in Canada
(excluding Ontario) were born to women aged 30 and over.
By 2000, the
number of mothers over 30 years of age had increased to
42%.
Care during childbirth varies in urban
and rural areas. In rural
areas, there is less capability for caesareans and there
are fewer
anaesthesia services available than in the cities. The
mix of care
providers also differs. Rural family doctors are more
likely to attend
births, while there are fewer specialists, obstetricians,
and
anaesthesiologists per capita in rural areas than in
cities.
Birth rates in the far North are among
the highest in the country.
Women in the far North with complications, or those
requiring a
caesarean birth, still often travel south to a hospital;
but new
options, such as birthing centres, are now available in some
northern
communities. In northern Ontario, however, fewer community
hospitals
are offering obstetrical services: 36 of 39 communities did
so in
1981, compared with 24 in 1999, according to research by
Peter
Hutten-Czapski of the University of Ottawa.
An increasing number of expecting mothers
(3% nationwide in
2000–2001) reported eeceiving prenatal care from midwives.
The
number of jurisdictions regulating and funding midwives
in Canada is
increasing—and so is the number of trained midwives. Their
participation in births is also rising. Ontario, for example,
saw
nearly a seven-fold increase between 1994–1995 and
2000–2001 in hospital births attended by midwives.
Canadian Institute for Health Information
(CIHI)
The Canadian Institute for Health Information (CIHI)
is an
independent, pan-Canadian, not-for-profit organization
working to
improve the health of Canadians and the health care system
by
providing quality health information. CIHI's mandate,
as
established by Canada's health ministers, is to coordinate
the
development and maintenance of a common approach to health
information
for Canada. To this end, CIHI is responsible for providing
accurate
and timely information that is needed to establish sound
health
policies, manage the Canadian health system effectively
and create
public awareness of factors affecting good heath.
Contact
Anick Losier
Media Relations
Tel. (613) 241-7860-4004
Cell. (613) 294-9544
Email:media @ cihi.ca
Leona Hollingsworth
Media Relations
Tel. (613) 241-7860 *4140
Email:media @ cihi.ca
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