"There is a misconception that the overall increase of cesarean births is the result of maternal request," says lead author Gillian Hanley, a PhD student in the UBC School of Population and Public Health. "Our analysis of B.C. data shows that this is not the case."
Published in the June issue of the journal Obstetrics & Gynecology, the UBC study examined all deliveries in B.C. between 2004 and 2007 and found an average of 21.2 per 100 deliveries were first-time C-sections and 14.2 per 100 deliveries were assisted vaginal deliveries involving the use of forceps and/or vacuum devices. Dystocia – or abnormal or difficult childbirth – was the most common reason for cesarean deliveries (30 per cent), followed by non-reassuring fetal heart rate (19.1 per cent).
Canada's cesarean delivery rate has increased dramatically over the past two decades, reaching an all time high of 26.3 per cent of in-hospital deliveries in 2005-2006. Until recently, B.C. had the highest cesarean rate in the country, according to the Canadian Institute for Health Information.
The study also found significant regional variations in cesarean and assisted vaginal delivery rates across B.C.'s 16 Health Services Delivery Areas that could not be explained by accounting for medical indications for these procedures. Cesarean delivery rates ranged from 27.5 per cent in the South Vancouver Island area to 16.1 per cent in Kootenay Boundary. Assisted vaginal delivery rates ranged from 18.6 per cent in Vancouver to 8.6 per cent in East Kootenay.
"In other words, some regions are either performing too many or too few cesareans after taking into consideration the characteristics and conditions of the mothers," says Hanley, also a researcher at the UBC Centre for Health Services and Policy Research.
"Our study doesn't attempt to determine the ideal rate of cesarean or assisted vaginal delivery," says Hanley. "But since regional variation is a fundamental principal in assessing the quality of health care, we need to further investigate the reason behind these large differences within the province's system."
The researchers suggest potential reasons may include the differences in practitioners' responses to similar medical situations, such as dystocia, including how they interpret and respond to the condition, and how they factor the resources available to them into their decisions.
"For example, smaller institutions may lack the resources required to respond to medical emergencies in the same manner as a tertiary care facility," says Hanley. "It is therefore more likely for practitioners there to recommend a cesarean delivery with a lower medical threshold.
"These hypotheses should be further investigated and may include non-medical factors such as socio-economic status," says Hanley. "But the findings point to a need for revising current national guidelines regarding the management of dystocia."
Co-authors of the study include Assoc. Prof. Patricia Janssen at the School of Population and Public Health and Devon Greyson, data specialist at the Centre for Health Services and Policy Research.
Brian Lin | EurekAlert!
Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland
Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke
Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.
The results will be published on March 22 in the journal „Astronomy & Astrophysics“.
Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...
Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.
Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...
In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...
20.03.2017 | Event News
14.03.2017 | Event News
07.03.2017 | Event News
24.03.2017 | Materials Sciences
24.03.2017 | Physics and Astronomy
24.03.2017 | Physics and Astronomy