Caesarean Section Rates in the Land of the Midnight Sun: a quality improvement project

• Main Authors: Burch, Tanya, Huynh, Steven, Meisner, Jennifer
• Format: Article in Journal/Newspaper
• Language: English
• Published: UBC Journal of Family Practice Research and Scholarship 2017
• Subjects: Canada; Caesarean Section/statistics & numerical data; Female; Pregnancy; Quality Improvement; Inuvik; Northwest Territories; midnight sun
• Online Access: http://ojs.library.ubc.ca/index.php/familypractice/article/view/189525

Introduction: Inuvik, Northwest Territories has had a significant decline in theircaesarean section rate. The groups that contributed most significantly to the decreased caesarean section (CS) rate have been analyzed with the goal of identifying prior effective program changes and areas for further improvement in the quality of obstetrical care in Inuvik.Description: A retrospective chart review was performed to identify all births in the Inuvik obstetrical program from 2012-2015. Data was then grouped into the Robson Classification categories in order to analyze the overall CS rate, the size of each group and relative contribution of each group to the CS rate between the 2012-2013, and 2014-2015 fiscal years.Evaluation: The CS rate in Inuvik declined from 26% 2012-2013 to 18% in 2014-2015, with an average CS rate of 22% over the 4 years. The group contributing the most to theoverall caesarean section rate was group 5, with decreasing rates of 83% to 78% over the 2012-2015 years respectively. The second largest contributing groups were groups 1 and 2 with changing rates of 19% to 9%, and 26% to 44%, respectively. The groups that most significantly contributed to the decline in the CS rate across the years were groups 1 and 4, with a decreased in the rate of 10% and 32% respectively. There was an overall decline in the primary CS rate by 5% and 4% in nulliparous and multiparous women respectively.Conclusions: The distribution of sizes of groups and contribution to the CS rate was found to be similar in Inuvik to previous studies across Canada. The decline in CS rate can be attributed to a combination of a decline in overall primary CS rates in Nulliparous women in spontaneous labour and multiparous women in induced labour or CS prior to labour (Groups 1 and 4). Women with a previous CS (Group 5) contributed most significantly to the CS rate, and did see an increase in attempted VBAC with decrease in CS rate, although to a lesser degree than Groups 1 and 4. Nulliparous women being induced (Group 2A) had a ...