Small hospital obstetrics: is small beautiful?

The number of deliveries in small Canadian hospitals over the last 15 years was reviewed. The two provinces with the highest percentage of deliveries in small hospitals had similar patterns of Perinatal Mortality Rates to the two provinces with the lowest percentage of small hospital deliveries. Birthweight specific mortality rates for newborns weighing greater than 2,500 grams was lower in small hospitals compared to larger hospitals in the provinces of Ontario, Newfoundland and Saskatchewan for 1985. In Ontario, for the year 1985, even when corrected for perinatal transfers and the home address of the mother, there were no significant differences in perinatal mortality between those hospitals with less than 400 births, those between 401 and 2,999 births and those with 3,000 or more births. Within the present Canadian system of perinatal regionalization, small hospital obstetrics is safe.