This paper, using data for the United States and Canada on number of births by day of the week, presents indirect evidence for the widespread incidence of the practice of elective induction. For both the United States and Canada, it is found that substantially fewer births occur on Saturdays, Sundays, and holidays than on weekdays. Controlling for such factors as prenatal care, race, education, legitimacy, birth weight, and time trend strongly suggests that the induction of labor is responsible for the patterns found. The paper concludes by discussing the framework within which the practice of elective induction of labor should be evaluated and justified.
Until recently, deliveries usually took place at local hospitals. In 2001- 2003, new guidelines were introduced to streamline the criteria for referral to the obstetrical department in Nuuk. This led to an increase in the proportion of deliveries in Nuuk but met with some public criticism. The purpose of this article is to describe the policies for delivery in a historical context and to analyse the response of the general population to the question of what is the preferred place of delivery.
Cross-sectional countrywide health interview surveys conducted in 1993-1994 and 2005-2008.
In 1993-1994 and 2005-2008, 1,219 and 2,154 adult survey participants lived outside Nuuk and answered questions about their preferred place for deliveries in cases of normal and at-risk pregnancies. Answers were analysed according to age, gender, ethnic group, social position and place of residence.
The percentage of women from other towns who gave birth at the central hospital in Nuuk almost doubled from 2001 to 2005, increasing from 10.1% to 19.8%. In 1993-1994, 74.2% of survey participants preferred to have normal deliveries at the local hospital compared with 85.3% in 2005-2008. In 1993-1994, 21.3% preferred having at-risk deliveries at the obstetrical department in Nuuk compared with 45.7% in 2005-2008.
The general population has increasingly accepted the professional point of view that deliveries should take place in hospital and in a specialized department if needed. Whether this is due to the increased focus of the health care professionals on referrals since 2001 or to general societal changes is not known.
Although the programs are of increasing popularity, little has been published on the effects of discharging maternity patients early from the hospital. In particular, there is almost no evidence to date to prove that these programs actually achieve two objectives for which they were designed; to reduce occupancy pressure on maternity beds and to lower hospital costs. Evaluation of the early stages of a relatively small and flexible maternity early discharge program in Alberta, Canada suggests that the program is effective in reducing length of stay in the hospital and hospital costs, but there is little evidence that it is actually used to reduce pressure on bed space in the maternity unit.
This study examines the possible reasons for increased obstetric activity in Denmark over the past 25 years. Since 1960 there has been a substantial increase in the average number of hospital admissions (from 10 to 32 per 100 deliveries), in deliveries diagnosed as complicated (from 15 to 49%), and above all in major interventions at delivery (from 4 to 22%). In spite of this increase in activity there is no evidence that the postwar trend of decreasing perinatal mortality has been further improved during the period of study. It seems possible that the rising level of activity is the result of increasing availability of new technology, decreasing numbers of deliveries and unchanged obstetric staffing levels, with an increased tendency to diagnose and intervene in "at risk" pregnancies. There is a need to determine how the current level of obstetric activity has arisen. Since there is evidence for an increased expectation of intervention by pregnant women, the theory of supplier induced demand may be among the leading contenders to be tested.
Pages 481-484 in H. Linderholm et al., eds. Circumpolar Health 87. Proceedings of the Seventh International Congress on Circumpolar Health, Umeå, Sweden, 1987. Arctic Medical Research. 1988;47 Supp 1.
Department of Community and Health Sciences, University of Manitoba, Winnipeg
Keewatin Zone Medical Services
Churchill Health Center, Churchill
Department of Obstetrics, Health Science Center, Winnipeg, Manitoba, Canada
Source
Pages 481-484 in H. Linderholm et al., eds. Circumpolar Health 87. Proceedings of the Seventh International Congress on Circumpolar Health, Umeå, Sweden, 1987. Arctic Medical Research. 1988;47 Supp 1.
The purposes of the paper are to describe changes in the technologic methods used in Finnish obstetric practice and to relate them to some measures of infant and mother health. Antenatal care in Finland still largely retains its original low-technology character, but changes toward more technology-oriented care can be seen. The management of labor and deliveries changed dramatically in the latter half of the 1960s and in the 1970s. More and more births occurred in large, specialized hospitals instead of in small, local hospitals. Electronic fetal monitoring, drug treatment of labor (oxytocin and analgesia), deliveries with instruments, and cesarean sections became common. Comparisons of perinatal mortality by county and by hospital suggest that the correlations between the technologic methods studied, especially cesarean sections, and decreasing perinatal mortality probably do not reflect direct causal relationships.
BACKGROUND: It has long been a common belief in Norway that all pregnant women attend antenatal care, but no documentation has been provided. In 1984, official guidelines were issued recommending a reduction of the number of routine visits. However, no studies have been performed in order to monitor whether the recommendations are followed. AIMS: Utilization review of antenatal care in Norway. METHOD: A national cross-sectional study, comprising all deliveries in all obstetrical units in the country during a two-week registration period in June 1996. Information on onset of antenatal care, the number of visits, parity and gestational age at the time of delivery was collected. The study comprised 1,557 deliveries; 45 of the 60 obstetrical units in the country participated. RESULTS: The mean number of antenatal visits was 12.2. Only two of the 1,557 women (0.1%) delivered without any previous antenatal care. A total of 80% started antenatal care in the first trimester, 0.4% had their first antenatal visit in the third trimester. The mean number of antenatal visits was substantially higher than the recommended number. CONCLUSION: Antenatal care-providers do not comply with the official guidelines.
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 2689.
This article describes provincial variations in women's hospital use during pregnancy, childbirth and the postnatal period.
The data were extracted from the Person-Oriented Information Data Base, maintained by Health Statistics Division at Statistics Canada. This data base is comprised of hospital admission data submitted by general and allied hospitals to provincial and territorial governments and is considered complete for each jurisdiction. Data were not available for the Yukon Territory.
A group of 57,627 women who gave birth during October and November 1993 was identified from hospital admission records using selected ICD-9 and CCP codes. These records were then linked to other hospital admissions that occurred in the six months before and the four months after childbirth.
Approximately 15% of women who gave birth in October and November 1993 were admitted to hospital at least once during the six months before childbirth. Only 4% were re-admitted during the four months after the birth.
