Temporal-spatial trends in childbirth in Ontario, Canada

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Services Research

Background:

• Understanding the continuum of perinatal and postpartum care is crucial for health system monitoring and quality improvement.
• This study examines long-term changes in obstetric care from a broad, longitudinal perspective.

Purpose of the Study:

• To analyze year-over-year changes in socio-demographics, clinical factors, care patterns, and perinatal/postpartum outcomes in Ontario from 2010-2023.
• To identify trends in obstetric care and maternal/infant outcomes over a 14-year period.

Main Methods:

• Retrospective, population-based study of all liveborn deliveries in Ontario, Canada (2010-2023).
• Utilized the hospital Discharge Abstract Database to link delivery and newborn records.
• Reported changes in demographics, clinical factors, care patterns, and outcomes.

Main Results:

• Maternal age at delivery increased, as did the incidence of pre-existing/gestational diabetes, obesity, pre-eclampsia, and liver disorders.
• Cesarean section rates rose, while median length-of-stay decreased; epidural use increased non-linearly.
• Obstetric and birth trauma rates increased, while six-month post-delivery mortality remained stable and infant mortality decreased.

Conclusions:

• Over 14 years, there has been a significant increase in individuals giving birth at older ages with more complex clinical characteristics.
• Observed variations in service utilization, including midwifery care and epidural access, across hospitals.