Rural women have twice childbirth risk of urban counterparts: Study

Authors say maternity unit closures in their communities partly to blame

Women in rural Canada have twice the risk of some life-threatening complications when they give birth, compared to urban women, a new study suggests.

The researchers found that rural mothers were twice as likely to have potentially life-threatening conditions such as eclampsia (serious seizures in women during pregnancy or childbirth), obstetric shock and rupture or tearing of the uterus, or breakdown of a uterine scar, compared with their urban counterparts. wait times for hip and knee surgery.”

Those wait times, once among the longest in the province, are now “really good,” LeClerc said — “very close” to the provincial target, which says 90 per cent of those needing the surgeries should get it within 182 days.

Nor is there any significant variation in wait times among different hospitals for knee and hip replacements, she said, thanks to a centralized intake system introduced a few years ago.

When the LHIN looked at the number of Pembroke and Renfrew County residents travelling to Ottawa for orthopedic surgery, the decision to develop a full-service hub in Pembroke was easy to justify, LeClerc said.

“There’s enough of a demand in Pembroke to support at least three full-time orthopedic surgeons,” she said. That’s vital, because it would be

The study in the Canadian Medical Association Journal by the University of Ottawa and University of British Columbia looked at a quarter of a million births in B.C. over five years.

It says the findings apply to other provinces as well.

The authors blame, in part, the closing of maternity units in many rural communities.

They say the higher rural risk of eclampsia suggests a “lack of appropriate impossible to operate a full-service program with fewer surgeons. “You need enough doctors to be on call after hours and on the weekends.”

Demand for orthopedic procedures has been growing steadily. In 2011, the Champlain LHIN estimated it would increase by 22 per cent over 10 years, with no additional resources clinical management or timely access to advanced obstetric care.” Among the findings:

Mothers in rural areas were younger when they gave birth, more often smoked or consumed drugs or alcohol during pregnancy, had more previous children before this study, and had fewer prenatal visits. They were more likely to have high blood pressure and to have a midwife involved in prenatal care. to meet the demand.

“We know that the population is getting older, and that typically points to an increased need for orthopedic services,” said LeClerc.

The redistribution will also affect the Kemptville District Hospital, which currently provides day surgery and low-complexity in-patient orthopedic services on a stand-alone basis.

Going forward, however, the hospital will deliver in-patient orthopedic services as a satellite of an existing full-service orthopedic hub — probably The Ottawa Hospital.

While there will likely be fewer knee replacements and other elective surgeries at the Kemptville hospital, those who need those surgeries will still be able to get them done there, LeClerc said. “Anybody in the Champlain region has a choice where they want to receive their surgery.”

Babies born in rural areas were more often premature and more often had low Apgar scores — an overall measure of wellness at birth.

“In the wake of maternity unit closures in rural areas, the emphasis should remain on monitoring for potentially life-threatening maternal and perinatal complications requiring advanced obstetric and neonatal care,” the authors write.

All orthopedic surgeries done on children will continue to take place at the Children’s Hospital of Eastern Ontario for now.

“At this point, we’re not moving around funding associated with pediatric orthopedic surgery,” LeClerc said. “That’s something, though, that we want to look at.”

The decision by the LHIN board requires Pembroke Regional Hospital to work with CHEO to examine whether it makes sense to deliver orthopedic services for children in Pembroke.

The impending shifts are just the first step in a bigger plan to create a “fully integrated and co-ordinated” orthopedic program for the entire Champlain region — one that would include other services, such as ankle, foot, shoulder and spinal surgeries, LeClerc said.

We don’t expect this is going to have any negative effect on the population of Ottawa.