Advertisement
JOGC
Advanced searchSave search
Obstetrics| Volume 42, ISSUE 5, P601-606, May 2020

Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical Program in Northwestern Ontario

Published:January 24, 2020DOI:https://doi.org/10.1016/j.jogc.2019.08.024
Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical Program in Northwestern Ontario
Previous ArticleSociodemographic Characteristics and Clinical Outcomes of People Receiving Inadequate Prenatal Care: A Retrospective Cohort Study
Next ArticleRisk of Cervical Dysplasia After Colposcopy Care and Risk-Informed Return to Population-Based Screening: A Systematic Review

      Abstract

      Objective

      To examine rates of cesarean delivery (CD) and vaginal birth after cesarean delivery (VBAC) and the patient profile in a community-based obstetrical practice.

      Methods

      Retrospective data from 2012 to 2017 for the Sioux Lookout Meno Ya Win Health Centre (SLMHC) were compared to data from the 30 hospitals providing the same level of services (Maternity 1b: maternity care by family physicians/midwives with CD and VBAC capacity) and Ontario. SLMHC VBAC patients were then compared to the general SLMC obstetrical population. Data included maternal age, parity, comorbidities, CD, VBAC, neonatal birth weight, and Apgar scores.

      Results

      The SLMHC obstetrical population differed from comparable obstetrical programs, with significantly higher rates of alcohol, tobacco, and opioid use and a higher prevalence of diabetes. CD rates were significantly lower (25% vs. 28%), and women delivering at SLMHC chose a trial of labour after CD almost twice as often (46% vs. 27%), resulting in a significantly higher VBAC rate (31% vs. 16%). Patients in the VBAC population differed from the general SLMHC obstetrical population, being older (7 years) and of greater parity. The neonates of VBAC patients had equivalent Apgar scores but lower rates of macrosomia and lower birth weights, although the average VBAC birth weight at 3346 g was equivalent to the provincial average.

      Conclusion

      The SLMHC obstetrical program has lower CD and higher VBAC rates than expected, despite prevalent risk factors typically associated with CD. Our study demonstrates that VBAC can be safely performed in well-screened and monitored patients in a rural setting with emergency CD capacity.

      Résumé

      Objectif

      Examiner les taux de césarienne et d'accouchement vaginal après césarienne (AVAC) ainsi que le profil des patientes dans le cadre d'une pratique obstétricale communautaire.

      Méthodologie

      Les auteurs ont comparé les données rétrospectives du Sioux Lookout Meno Ya Win Health Centre (SLMHC) de 2012 à 2017 aux données tirées de 30 hôpitaux qui offrent le même niveau de services (niveau 1b : soins de maternité prodigués par des médecins de famille et sages-femmes, dans un établissement où il est possible de réaliser des AVAC et césariennes) en Ontario. Les patientes ayant eu un AVAC au SLMHC ont ensuite été comparées à la population obstétricale générale du même établissement. Les données comprenaient l'âge maternel, la parité, les comorbidités, la césarienne, l'AVAC, le poids à la naissance et l'indice d'Apgar.

      Résultats

      La population obstétricale du SLMHC différait des populations de programmes obstétricaux comparables; elle présentait des taux considérablement plus élevés de tabagisme et de consommation d'alcool et d'opioïdes, ainsi qu'une prévalence accrue de diabète et un taux de césarienne significativement inférieur (25 % c. 28 %). Les femmes ayant accouché au SLMHC ont choisi presque deux fois plus souvent de se soumettre à une épreuve de travail après la césarienne que les femmes des autres populations (46 % c. 27 %), ce qui a donné lieu à un taux d'AVAC considérablement supérieur (31 % c. 16 %). Les patientes de la population ayant eu un AVAC étaient plus âgées de 7 ans en moyenne et avaient donné naissance à un plus grand nombre d'enfants que les femmes de la population obstétricale générale du SLMHC. Les nouveau-nés des patientes ayant subi un AVAC avaient un indice d'Apgar égal à celui des autres populations, mais présentaient un taux inférieur de macrosomie et un plus petit poids à la naissance, même si le poids à la naissance moyen des bébés nés par AVAC, qui s'élevait à 3 346 g, équivalait à la moyenne provinciale.

      Conclusion

      Le programme obstétrical du SLMHC présente un taux de césarienne inférieur et un taux d'AVAC supérieur aux attentes, en dépit des facteurs de risque généralement associés à la césarienne. L'étude indique que l'AVAC peut être réalisé de manière sécuritaire chez des patientes dont l'état de santé a été bien évalué et qui demeurent sous surveillance, dans un établissement en milieu rural doté de la capacité de pratiquer des césariennes d'urgence.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Liu S
        • Rusen I
        • Joseph K
        • et al.
        • Maternal Health Study Group of the Canadian Perinatal Surveillance System
        Recent trends in caesarean delivery rates and indications for caesarean delivery in Canada.
        J Obstet Gynaecol Can. 2004; 26: 735-742
        View in Article
        • Kelly S
        • Sprague A
        • Fell D
        • et al.
        Examining Caesarean section rates in Canada using the Robson classification system.
        J Obstet Gynaecol Can. 2013; 35: 206-214
        View in Article

      3. Canadian Institute for Health Information. Childbirth incidence by place of residence. April 19, 2018. Available at: www.cihi.ca/en/c-section-rates-continue-to-increase-while-birth-rates-decline. Accessed May 31, 2019.

        View in Article

      4. Statistics Canada. Live births, mean and median birth weight. Table 13-10-0423-01. Live births, mean and median birth weight, by sex. May 31, 2019. Available at: www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310042301&pickMembers%5B0%5D=1.7. Accessed May 31, 2019.

        View in Article
        • Oliveira A
        • Kalra S
        • Wahi G
        • et al.
        Maternal and newborn health profile in a First Nations community in Canada.
        J Obstet Gynaecol Can. 2013; 35: 905-913
        View in Article

      6. Roukema H.Levels of care for maternal and newborn services in Ontario. Ontario Provincial Council for Maternal and Child Health. Available at:www.pcmch.on.ca/wp-content/uploads/2015/07/Levels-of-Care-for-Maternal-and-Newborn-Services-in-Ontario.pdf. Accessed April 18, 2019.

        View in Article

      7. Sioux Lookout First Nations Health Authority. Our Children and Youth Health Report. Sioux Lookout, ON; 2018. Available at: slfnha.com/application/files/6215/4022/0883/CHSR_FINAL_-_Web_Version.pdf. Accessed June 10, 2019.

        View in Article
        • Walker R
        • Cromarty H
        • Kelly L
        • et al.
        Achieving cultural safety in Aboriginal health services: implementation of a cross-cultural safety model in a Hospital Setting.
        Divers Health Care. 2009; 6: 11-22
        View in Article

      9. Sioux Lookout First Nations Health Authority. Raising our Children, Full Spectrum Indigenous Doula Training Program. Sioux Lookout, ON; 2019. Available at: www.slfnha.com/health-services/approaches-community-wellbeing/raising-our-children. Accessed August 14, 2019.

        View in Article

      10. Sioux Lookout Meno Ya Win Health Centre. Maternal-infant support workers program. SLMHC News 2013;11:1. Available at: slmhc.on.ca/assets/files/11_December_2013.pdf. Accessed August 14, 2019.

        View in Article
        • Dooley J
        • Kelly L
        • St Pierre-Hansen N
        • et al.
        A rural family physician-managed Aboriginal obstetrical program: Sioux Lookout Meno Ya Win Obstetrics.
        Can J Rural Med. 2009; 14: 75-79
        View in Article
        • Ryan G
        • Dooley J
        • Gerber Finn L
        • et al.
        Maternal-fetal monitoring of opioid-exposed pregnancies: analysis of a pilot community-based protocol and review of the literature.
        J Obstet Gynaecol Can. 2017; 39: 443-452
        View in Article
        • Martel M
        • McKinnon C.
        Guidelines for vaginal birth after previous Caesarean birth.
        J Obstet Gynaecol Can. 2018; 40: e195-e207
        View in Article

      14. Health Quality Ontario, Provincial Council for Maternal and Child Health. Vaginal birth after Caesarean (VBAC) quality standard. Available at: www.pcmch.on.ca/health-care-providers/maternity-care/pcmch-strategies-and-initiatives/vaginal-birth-caesarean-quality-standard/. Accessed April 30, 2019.

        View in Article
        • Brill Y
        • Windrim R
        Vaginal birth after Caesarean section: review of antenatal predictors of success.
        J Obstet Gynaecol Can. 2003; 25: 275-286
        View in Article
        • Sokolowski E.
        Canadian First Nations women's beliefs about pregnancy and prenatal care.
        Can J Nurs Res. 1995; 27: 89-99
        View in Article
        • O'Driscoll T
        • Payne L
        • Kelly L
        • et al.
        Traditional First Nation's birthing practices: interviews with elders in northwest Ontario.
        J Obstet Gynaecol Can. 2011; 33: 24-29
        View in Article
        • O'Driscoll T
        • Kelly L
        • Payne L
        • et al.
        Delivering away from home: understanding the perinatal experiences and needs of First Nations women in northwest Ontario.
        Can J Rural Med. 2011; 16: 126-130
        View in Article
        • Sheppard A
        • Shapiro G
        • Bushnik T
        • et al.
        Birth outcomes among First Nations, Inuit and Métis populations.
        Health Rep. 2017; 28: 11-16
        View in Article

      20. Cree Board of Health and Social Services of James Bay. Summary health profile March 11, 2016. Background summary statistical profile of health and health determinants in Eeyou Istchee for the Health Assembly. Available at: www.creehealth.org/sites/default/files/A%20Health%20Profile%20for%20Health%20Assembly.pdf. Accessed February 5, 2019.

        View in Article
        • Canadian Institute for Health Information (CIHI)
        Hospital Births in Canada: A Focus on Women Living in Rural and Remote Areas.
        CIHI, Ottawa, ON2013
        View in Article
        • Garrison L
        • Leeman L
        • Savich RD
        • et al.
        Fetal growth outcomes in a cohort of polydrug- and opioid-dependent patients.
        J Reprod Med. 2016; 61: 311-319
        View in Article
        • Anand SS
        • Yusuf S
        • Jacobs R
        • et al.
        Risk factors, atherosclerosis, and cardiovascular disease among Aboriginal people in Canada: the Study of Health Assessment and Risk Evaluation in Aboriginal Peoples.
        Lancet. 2001; 358: 1147-1153
        View in Article
        • Bruce SG
        • Riediger ND
        • Zacharias JM
        • et al.
        Obesity and obesity-related comorbidities in a Canadian First Nation population.
        Prev Chronic Dis. 2011; 8: A03
        View in Article
        • Knight KM
        • Thornburg LL
        • Pressman EK
        Pregnancy outcomes in type 2 diabetic patients as compared with type 1 diabetic patients and nondiabetic controls.
        J Reprod Med. 2012; 57: 397-404
        View in Article
        • Al-Qahtani S
        • Heath A
        • Quenby S
        • et al.
        Diabetes is associated with impairment of uterine contractility and high Caesarean section rate.
        Diabetologia. 2012; 55: 489-498
        View in Article
        • Araujo JE
        • Peixoto AB
        • Zamarian AC
        • et al.
        Macrosomia.
        Best Pract Res Clin Obstet Gynaecol. 2017; 38: 83-96
        View in Article
        • Dzakpasu S
        • Fahey J
        • Kirby RS
        • et al.
        Contribution of prepregnancy body mass index and gestational weight gain to caesarean birth in Canada.
        BMC Pregnancy Childbirth. 2014; 14: 1-12
        View in Article
        • Gaudet L
        • Wen SW
        • Walker M
        The combined effect of maternal obesity and fetal macrosomia on pregnancy outcomes.
        J Obstet Gynaecol Can. 2014; 36: 776-784
        View in Article
        • Young C
        • Liu S
        • Muraca G
        • et al.
        Mode of delivery after a previous cesarean birth and associated maternal and neonatal morbidity.
        CMAJ. 2018; 190: E556-E564
        View in Article

      Article info

      Publication history

      Published online: January 24, 2020

      Footnotes

      Competing Interests: The authors declare that they have no competing interests.

      Each author has indicated that they meet the journal's requirements for authorship.

      Identification

      DOI: https://doi.org/10.1016/j.jogc.2019.08.024

      Copyright

      © 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX