Temporal-spatial trends in childbirth in Ontario, Canada

Abstract

Introduction The importance of understanding the continuum of care throughout the perinatal/postpartum periods is important for health system monitoring and quality improvement. In this study, we take a broad-ranging and longitudinal perspective to examining long-term changes in obstetric care. Methods This is a retrospective population-based study including all liveborn deliveries from 2010–2023 in Ontario, Canada. We used the hospital Discharge Abstract Database to link delivery and newborn abstracts. We report year-over-year changes in socio-demographics, clinical factors, care patterns, and perinatal and postpartum outcomes. Results The number of in-hospital births decreased from 133,957 in 2010–127,660 in 2023. Over the study period, delivery age increased from a mean 30.6 years (SD 5.5) in 2010 to 32.2 (SD 4.9) in 2023 and there was at least a doubling in the proportion of persons who delivered having preexisting/gestational diabetes (5.6% in 2010, 11.1% in 2023), obesity (1.6% in 2010, 4.6% in 2023), pre-eclampsia/eclampsia (1.1% in 2010, 2.6% in 2023), liver disorders (0.43% in 2010; 1.16% in 2023), and other diseases (4.9% in 2010, 10.7% in 2023), p < 0.0001 for all. The proportion of deliveries performed via C-section increased over time (29.3% in 2010, 34.6% in 2023) but the median length-of-stay decreased 2.68% year-over-year. Use of epidural increased non-linearly over the study period and was less likely at lower-volume hospitals. Although uncommon (<5%), the rate of obstetric trauma and birth trauma increased over the study period, regardless of the mode of delivery (p < 0.0001). Six-month mortality did not change over the study period after delivery, while infant mortality decreased (0.35% in 2010 to 0.26% in 2023). We also observed substantial hospital-level variation in utility of services including midwifery care and access to epidural. Conclusion Over the last 14 years, we found an increasing incidence of people giving birth at an older age and having complicating clinical characteristics at the time of delivery.