Rates of interventions in labor and birth across Canada: findings of the Canadian Maternity Experiences Survey.

BACKGROUND

Rates of interventions in labor and birth should be similar across a country if evidence-based practice guidelines are followed. This assumption is tested by comparison of some practices across the 13 provinces and territories of Canada. The objective of this study was to describe the wide provincial and territorial variations in rates of routine interventions and practices during labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System.

METHODS

A sample of 8,244 eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census. The sample was stratified by province and territory. Computer-assisted telephone interviews were conducted with participating birth mothers by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews took an average of 45 minutes and were completed when infants were between 5 and 10 months old (9-14 mo in the territories). Completed responses were obtained from 6,421 women (78%).

RESULTS

Provincial and territorial variations in rates of routine intervention used during labor and birth are reported. The percentage range of mothers' experience of induction (range 30.9%), epidural (53.7%), continuous electronic fetal monitoring (37.9%), and medication-free pain management during labor (40.7%) are provided, in addition to the use of episiotomy (14.1%) or "stitches" (48.3%), being in a "flat lying position" (42.2%), and having their legs in stirrups for birth (35.7%). Wide variations in the use of most of the interventions were found, ranging from 14.1 percent to 53.7 percent.

CONCLUSIONS

Rates of intervention in labor and birth showed considerable variation across Canada, suggesting that usage is not always evidence based but may be influenced by a variety of other factors.