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Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical Program in Northwestern Ontario.
J Obstet Gynaecol Can. 2020 May; 42(5):601-606.JO

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.

Authors+Show Affiliations

Northern Ontario School of Medicine, Sioux Lookout, ON; Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, ON.Northern Ontario School of Medicine, Sioux Lookout, ON; Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, ON; Thunder Bay Regional Health Research Institute, Thunder Bay, ON.BORN Ontario, Ottawa, ON.Northern Ontario School of Medicine, Sioux Lookout, ON; Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, ON.Northern Ontario School of Medicine, Sioux Lookout, ON; Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, ON.Northern Ontario School of Medicine, Sioux Lookout, ON; Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, ON.Anishnaabe Bimaadiziwin Research Program, Sioux Lookout, ON.Northern Ontario School of Medicine, Sioux Lookout, ON; Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, ON.Northern Ontario School of Medicine, Sioux Lookout, ON; Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, ON.Anishnaabe Bimaadiziwin Research Program, Sioux Lookout, ON. Electronic address: lkelly@mcmaster.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31987756

Citation

Dooley, Joseph, et al. "Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical Program in Northwestern Ontario." Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstetrique Et Gynecologie Du Canada : JOGC, vol. 42, no. 5, 2020, pp. 601-606.
Dooley J, Jumah N, Okenden H, et al. Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical Program in Northwestern Ontario. J Obstet Gynaecol Can. 2020;42(5):601-606.
Dooley, J., Jumah, N., Okenden, H., Madden, S., Bollinger, M., Sprague, C., Willms, H., Hummelen, R., Gerber Finn, L., & Kelly, L. (2020). Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical Program in Northwestern Ontario. Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstetrique Et Gynecologie Du Canada : JOGC, 42(5), 601-606. https://doi.org/10.1016/j.jogc.2019.08.024
Dooley J, et al. Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical Program in Northwestern Ontario. J Obstet Gynaecol Can. 2020;42(5):601-606. PubMed PMID: 31987756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical Program in Northwestern Ontario. AU - Dooley,Joseph, AU - Jumah,Naana, AU - Okenden,Holly, AU - Madden,Sharen, AU - Bollinger,Megan, AU - Sprague,Celia, AU - Willms,Hannah, AU - Hummelen,Ruben, AU - Gerber Finn,Lianne, AU - Kelly,Len, Y1 - 2020/01/24/ PY - 2019/07/12/received PY - 2019/08/14/revised PY - 2019/08/16/accepted PY - 2020/1/29/pubmed PY - 2020/1/29/medline PY - 2020/1/29/entrez KW - Indigenous peoples KW - cesarean section KW - vaginal birth after cesarean SP - 601 EP - 606 JF - Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC JO - J Obstet Gynaecol Can VL - 42 IS - 5 N2 - 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. SN - 1701-2163 UR - https://www.unboundmedicine.com/medline/citation/31987756/Cesarean_Delivery_and_Vaginal_Birth_After_Cesarean_Delivery_Rates_in_a_First_Nations_Community_Based_Obstetrical_Program_in_Northwestern_Ontario_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1701-2163(19)30768-6 DB - PRIME DP - Unbound Medicine ER -
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