Outcomes of maternity care services in Alberta, 1999 and 2000: a population-based analysis.

OBJECTIVE To evaluate the maternal and perinatal outcomes of Alberta's regionalized system of care. In particular, to compare the outcomes of communities with limited or no local intrapartum care with those of regional and tertiary care centres. METHODS We conducted a population-based retrospective study of all Alberta deliveries in 1999 and 2000. Maternal outcome measures were rates of patient outflow, induction of labour, Caesarean section (CS), and participation in vaginal birth after Caesarean section (VBAC). The perinatal outcome measure was the perinatal loss rate (mortality rate plus stillbirth rate). Rural maternity care programs were categorized as follows: no elective local maternity care (level 0), local maternity care without local CS capabilities (level IA), and local maternity care with local CS capabilities (level IC). RESULTS Communities offering intrapartum care without local CS capability delivered 22.1% of their maternity population. This proportion increased to 70.1% if the communities had local CS capabilities. Although patient outflow was associated with parity, risk, local services, and distance to an urban centre, there was a large unexplained outflow difference between communities with similar service levels. More limited local maternity care services and higher outflow rates were associated with higher rates of induction of labour. Rates for CS, participation in VBAC, and perinatal loss were not significantly different for different types of maternity care programs other than a lower CS rate for residents in type IA communities compared with other communities (18% vs. 20%). CONCLUSION The principal consequences of a limited scope of local maternity care services for rural women is an increased rate of induction of labour and, if they live in a community that delivers babies without local CS capability (IA), a lower CS rate. These category IA communities, with patient outflows of 78%, are largely unsuccessful in having women deliver locally, but women from these communities have a lower rate of CS wherever they deliver. The 18 rural Alberta maternity care programs where patient outflow is over 67% may not be sustainable.