"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!
WAKE-UP provides new treatment option for stroke patients | International study led by UKE
17.05.2018 | Universitätsklinikum Hamburg-Eppendorf
First form of therapy for childhood dementia CLN2 developed
25.04.2018 | Universitätsklinikum Hamburg-Eppendorf
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
The historic first detection of gravitational waves from colliding black holes far outside our galaxy opened a new window to understanding the universe. A...
A team led by Austrian experimental physicist Rainer Blatt has succeeded in characterizing the quantum entanglement of two spatially separated atoms by observing their light emission. This fundamental demonstration could lead to the development of highly sensitive optical gradiometers for the precise measurement of the gravitational field or the earth's magnetic field.
The age of quantum technology has long been heralded. Decades of research into the quantum world have led to the development of methods that make it possible...
Cardiovascular tissue engineering aims to treat heart disease with prostheses that grow and regenerate. Now, researchers from the University of Zurich, the Technical University Eindhoven and the Charité Berlin have successfully implanted regenerative heart valves, designed with the aid of computer simulations, into sheep for the first time.
Producing living tissue or organs based on human cells is one of the main research fields in regenerative medicine. Tissue engineering, which involves growing...
A team of scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg investigated optically-induced superconductivity in the alkali-doped fulleride K3C60under high external pressures. This study allowed, on one hand, to uniquely assess the nature of the transient state as a superconducting phase. In addition, it unveiled the possibility to induce superconductivity in K3C60 at temperatures far above the -170 degrees Celsius hypothesized previously, and rather all the way to room temperature. The paper by Cantaluppi et al has been published in Nature Physics.
Unlike ordinary metals, superconductors have the unique capability of transporting electrical currents without any loss. Nowadays, their technological...
02.05.2018 | Event News
13.04.2018 | Event News
12.04.2018 | Event News
18.05.2018 | Power and Electrical Engineering
18.05.2018 | Information Technology
18.05.2018 | Information Technology