BGH Obstetrics Statistics

In Brockville, 3 obstetricians, a group of midwives, and 2 family doctors offer maternity care including labour and delivery for women. Many family doctors provide prenatal care but do not deliver babies.

The department of obstetrics keeps close track of statistics like our primary c-section rate, our rate of success for VBAC patients, and our use of assisted delivery techniques such as vacuum, forceps, and episiotomy.

C-Section Rates:

The primary c-section rate is the number we are most concerned with. This is the number of women who have never had a c-section before, and who intended to have a vaginal delivery, but who end up having a c-section. Although the rationale and evidence for an “ideal” primary c-section rate is questionable, the WHO suggests that it should be 15% or less. Many hospitals struggle to reach this goal.

The total c-section rate includes women who have had a previous c-section who choose to have a scheduled repeat c-section with their subsequent children. It also includes a small number of women who choose not to try to have a vaginal delivery for their own reasons. The number of women who choose c-section is difficult to impossible to change, as this reflects the informed choices of these women. You should not be concerned with a hospital's TOTAL c-section rate, you should be looking at a hospital's PRIMARY c-section rate. These two numbers are often confused.

OB patients having primary c-sections: 13.2%

Midwifery in-hospital patients having primary c-sections: 16.1%

The repeat c-section rate is 15.7%, and the vast majority of these are obstetrics patients, as midwives do not perform c-sections. A few patients have their prenatal care with midwifery, usually because they are considering VBAC, but if they decide to have a repeat c-section they will then be seen by obstetrics.

Epidurals:

Anesthesia is on call 24 hours a day and provide epidurals for patients who want them. There can occasionally be delays in getting an epidural if the anesthetist on call happens to be caring for a patient who is already asleep and having surgery. In these cases, we try to find another anesthetist who is more readily available, but in some cases you may have to wait for the surgery to be finished before anesthesia can come to do your epidural.

If you are a midwife patient who wants to have an epidural, you should be aware that midwives in Brockville do not run epidurals. If you choose to have one, your care will be transferred to the obstetrician on call, and maternity nurses will take over the monitoring of your labour and the running of your epidural. In these cases of transfer of care, your midwife will often stay to play a supportive role.

OB patients who receive epidurals: 28.3%

Midwifery patients who receive epidurals: 28.6%

VBACs:

Both obstetrics and midwifery offer the option of vaginal birth after c-section. Obstetrics patients having a VBAC do so in the hospital, and we recommend continuous monitoring of the fetal heart rate in labour to help detect problems that may arise as early as possible. In well-selected patients, the rate of success is normally quite high. The best rates of success are with women who had a reason for their first c-section that is unlikely to recur.

Successful VBAC rate: 73%

Assisted Vaginal Delivery:

Assisted vaginal deliveries are deliveries that occur with the help of either forceps or vacuum, both of which allow the obstetrician to provide gentle pulling in conjunction with a patient’s pushing efforts in order to achieve a vaginal delivery. Midwives cannot perform assisted vaginal deliveries, therefore if this is required care is transferred to the obstetrician on call.

Episiotomy:

Episiotomy is a cut that is made on the perineum to make more space for the delivery of the baby. It is done in the same area where tearing often naturally occurs with delivery. Episiotomy is NOT part of the modern routine care of any patient, in obstetrics or midwifery. It is generally only done if there are complications that make some extra space necessary in order to expedite the delivery of a baby, for instance if your baby’s shoulders get stuck during delivery, or in some cases when forceps are used for delivery. Occasionally a patient may request that an episiotomy be done as she prefers that to the possibility of tearing.

Our episiotomy rate is consistently VERY low.

Transfer of Care to Obstetrics:

Midwives and family doctors care for low-risk women in labour and delivery. However, low-risk women can develop complications at any time that make them higher risk. When this happens, midwives and family doctors consult obstetrics and transfer care of their patients to them. There are also a variety of procedures or services that can only be provided by obstetrics and when these are needed, care is transferred.

Percentage of midwifery in-hospital patients whose care is transferred to OB: 48.9%

These transfers can be broken down by reason for transfer:

32.8% of midwifery transfers of care are because the patient received an epidural. Some of these women also go on to require other services that would also require a transfer of care such as an assisted vaginal delivery or c-section.
32.8% of midwifery transfers of care occurred because the patient required a primary c-section for delivery.
15.7% of midwifery transfers of care occurred because the patient required a repeat c-section for delivery. These include mostly women who were trying to have a VBAC and it didn't work, but also a few planned repeat c-sections.
18.7% of midwifery transfers of care occur for miscellaneous reasons including complications of pregnancy such as pre-eclampsia or preterm labour, or for assisted vaginal delivery.

Percentage of family doctor patients whose care is transferred to OB: 25%

This rate of transfer is lower than midwifery for a few reasons:

There has only been 1 family doctor doing deliveries until recently and the number of patients delivered is low
Family doctors can continue providing care when their patients request and receive an epidural
Family doctors generally refer patients wanting higher risk options such as VBAC to an obstetrician early on.

*These numbers are cumulative including all deliveries that occurred at BGH from 2014 to 2016. We will update as new info becomes available.