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    Caesarean delivery rates in Ontario vary significantly by hospital, even in low-risk populations. Induction policies may decrease caesarean rates in these women.

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    Area of Science:

    • Obstetrics and Gynecology
    • Public Health
    • Health Services Research

    Background:

    • In 2007, caesarean deliveries accounted for 28% of all hospital births in Ontario, with rates increasing with maternal age and varying by region.
    • The accepted caesarean delivery rate for low-risk maternal populations remains unclear, highlighting a need for further investigation.

    Purpose of the Study:

    • To systematically review literature to identify factors influencing caesarean delivery likelihood.
    • To analyze Ontario's caesarean delivery rates and regional variations.

    Main Methods:

    • A mixed-methods approach combining a systematic literature review with an analysis of administrative and clinical data from Ontario hospital deliveries.
    • Searched multiple databases including MEDLINE, Embase, CINAHL, and EBM Reviews for relevant publications.
    • Utilized data from the Canadian Institute for Health Information and Better Outcomes and Registry Network.

    Main Results:

    • A systematic review identified 14 factors affecting caesarean delivery likelihood: 7 increased the likelihood, 2 decreased it, and 5 had no influence.
    • Moderate-quality evidence suggests elective induction policies may decrease caesarean delivery rates in low-risk women compared to expectant management.
    • The overall caesarean delivery rate in a very-low-risk Ontario population was 17%, with significant variation observed across different hospitals.

    Conclusions:

    • An induction policy is associated with a reduction in caesarean delivery rates for low-risk women.
    • Significant variation in caesarean delivery rates exists among hospitals in Ontario.
    • Limitations include a focus on systematic reviews from a 5-year period and potential inclusion of data from women with conditions warranting caesarean delivery in the 'low-risk' group.