"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!
New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)
Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology
More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
20.04.2017 | Event News
18.04.2017 | Event News
03.04.2017 | Event News
25.04.2017 | Physics and Astronomy
25.04.2017 | Materials Sciences
25.04.2017 | Life Sciences