Highlights from the BORN Ontario LHIN Region Reports for 2009 2010 - PowerPoint PPT Presentation

Proportion of women <20 years at delivery Ontario † , 2005 – 2006 to 2009 – 2010 5 4 3.8 3.7 Percent (%) of women 3.6 3.6 3.4 3 Percent (%) 2 1 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 22

Proportion of women ≥ 35 years at delivery, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 15.6 South West (2) 14.6 Waterloo Wellington (3) 17.9 HNHB (4) 17.8 Central West (5) 18.5 Mississauga Halton (6) 24.6 Percent (%) Toronto Central (7) 32.9 Central (8) 26.5 Central East (9) 18.1 South East (10) 13.2 Champlain (11) 22.9 North Simcoe Muskoka (12) 15.9 North East (13) 10.5 North West (14) 11.4 ONTARIO 21.4 0 5 10 15 20 25 30 35 Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 23

Proportion of women ≥ 35 years at delivery Ontario † , 2009 – 2010 30 25.4 25 21.4 20.6 20 Percent (%) of women 17.9 Percent (%) 15.0 15 12.5 10 5 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 24

Proportion of women ≥ 35 years at delivery Ontario † , 2005 – 2006 to 2009 – 2010 30 25 20 Percent (%) of women 21.4 21.1 21.0 20.9 20.7 Percent (%) 15 10 5 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 25

Proportion of women who were nulliparous at delivery, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 39.9 South West (2) 42.6 Waterloo Wellington (3) 44.2 HNHB (4) 45.6 Central West (5) 41.1 Mississauga Halton (6) 43.7 Toronto Central (7) 49.7 Central (8) 43.2 Central East (9) 43.1 South East (10) 46.2 Champlain (11) 41.5 North Simcoe Muskoka (12) 45.7 North East (13) 45.9 North West (14) 39.3 ONTARIO 44.1 0 10 20 30 40 50 60 Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 26

Proportion of women who were nulliparous at delivery Ontario † , 2009 – 2010 60 50 45.0 44.8 44.4 44.1 42.6 41.6 Percent (%) of women 40 30 20 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 27

Proportion of women who were ≥ 35 years of age and nulliparous at delivery, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 22.5 South West (2) 23.9 Waterloo Wellington (3) 26.1 HNHB (4) 27.6 Central West (5) 19.6 Mississauga Halton (6) 25.9 Toronto Central (7) 37.3 Central (8) 26.0 Central East (9) 22.6 South East (10) 26.7 Champlain (11) 25.5 North Simcoe Muskoka (12) 27.4 North East (13) 27.1 North West (14) 22.3 ONTARIO 27.7 0 10 20 30 40 Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 28

Proportion of women who were ≥ 35 years of age and nulliparous at delivery Ontario † , 2009 – 2010 40 Percent of women with parity ≥ 2 (%) 28.9 30 27.7 27.1 26.3 25.7 23.4 20 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 29

30 Pregnancy Section II

Proportion of women who did not attend an antenatal visit with a health care provider during the first trimester, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 19.0 South West (2) 10.6* Waterloo Wellington (3) 9.0 HNHB (4) 8.1 Central West (5) 30.1* Mississauga Halton (6) 7.9 Percent (%) Toronto Central (7) ** Central (8) 14.4* Central East (9) ** South East (10) 6.7 Champlain (11) 10.1 North Simcoe Muskoka… 9.4 North East (13) 15.9 North West (14) 14.6 ONTARIO 14.1* 0 5 10 15 20 25 30 35 Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 31 * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates ** Estimate not shown because more than 30% of records had missing information

Proportion of women who did not attend an antenatal visit with a health care provider during the first trimester Ontario † , 2009 – 2010 20 17.7* 15 14.2* 14.1* 13.4 Percent (%) of women Percent (%) 10 9.2* 8.5 5 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 32 * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates

Proportion of women with pre-existing health conditions Ontario † , 2009 – 2010 50 40 37.9 32.7 30.7 Percent (%) of women 30 28.1 27.7 24.8 20 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 33

Proportion of women with pre-existing health conditions Ontario † , 2005 – 2006 to 2009 – 2010 40 33.4 Percent (%) of women 30 29.3 28.3 27.3 24.5* 20 10 0 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 34 * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates

Proportion of women with obstetrical complications Ontario † , 2009 – 2010 50 39.9 40 35.2 Percent (%) of women 28.5 Percent (%) 30 27.9 25.0 24.3 20 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 35

Proportion of women with obstetrical complications Ontario † , 2009 – 2010 50 40 Percent (%) of women Percent (%) 30 27.9 26.2 17.1* 20 14.2* 9.6* 10 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 36 * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates

Rate of assisted conception, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 2.4 South West (2) 2.7 Waterloo Wellington (3) 2.4 HNHB (4) 2.9* Central West (5) 2.7 Mississauga Halton (6) 2.6 Toronto Central (7) 3.6* Central (8) 2.4 Central East (9) ** South East (10) 1.5 Champlain (11) ** North Simcoe Muskoka (12) 1.5 North East (13) 0.9* North West (14) 0.7 ONTARIO 2.3* 0 1 2 3 4 5 Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 37 * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates ** Estimate not shown because more than 30% of records had missing information

Rate of assisted conception Ontario † , 2009 – 2010 5 4 Percent (%) of women 3 2.7 2.6 2.6* 2.3* 2 1.1 1 ** 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 38 * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates ** Estimate not shown because more than 30% of records had missing information

Section III Maternity health services 39

Levels of care • Levels of care in Ontario hospitals are designated by the Ontario Ministry of Health and Long ‐ Term Care • These designations reflect the scope of medical services available at a particular hospital and define the maximum level of the acuity and complexity of mothers and infants who can be cared for at that hospital • All hospitals care for mothers and infants who are healthy (low risk) as well as those who are at the maximum level of acuity and complexity according to their hospital’s level of care designation 40

Levels of care • At the time these reports were prepared, five levels of care designation for maternal ‐ newborn services existed within Ontario: Level of care Description I Provide care for healthy mothers and infants >36 weeks’ gestation II/II+ Provide care for mothers and infants ≥ 32 weeks’ gestation Modified III (M3) Provide care for mothers and infants ≥ 29 weeks’ gestation without additional high risk maternal or fetal conditions III Provide care for all high ‐ risk pregnancies, including prematurity <32 weeks • In May 2011, recommendations regarding new maternal and newborn levels of care designation were announced by the Provincial Council for Maternal Child Health (PCMCH). These will likely phase in over the next several years and future BORN reports will reflect these new designations. 41

Distribution of live births at each level of care, by LHIN region of birth Ontario † , 2009 – 2010 • Across Ontario, the 100 majority of live births took place in a Level II hospital (42.1%), followed by 80 22.4% in a Level II+ hospital, 15.5% in a Level Percent (%) of live births III hospital, 13.3% in a 60 Level I hospital and 6.7% in a modified Level III hospital. 40 • Geographic differences in the distribution of live births at each level of care 20 reflect the type of hospitals available in each LHIN as well as health service issues and practice 0 ESC-SW (1&2) WW-HNHB GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO patterns. (3&4) Level I Level II Level II+ Level III Level M3 Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 42

Distribution of live births at each level of care, by gestational age at birth Ontario † , 2009 – 2010 • Across Ontario, the 100 proportion of live births that took place in a Level III hospital was highest in 80 infants born between 24 ‐ 31 weeks (77.0% for 24 ‐ 27 weeks, 62.4% for 28 ‐ 31 Percent (%) of live births weeks), which is the 60 optimal level of care for this gestational age. 40 • Approximately a quarter (26.7%) of infants born during a gestational period where survival is 20 extremely low (<24 weeks’ gestation) were born at a Level III centre. 0 <24 weeks 24-27 weeks 28-31 weeks 32-33 weeks 34-36 weeks ≥ 37 weeks Level I Level II Level II+ Level III Level M3 Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 43

44 Section IV Birth

Distribution of care provider who attended the hospital birth, by LHIN of birth Ontario † , 2009 – 2010 100 • Across Ontario, the majority of women had an obstetrician attend their hospital delivery (85.4%). 80 • The proportion of women whose care Percent (%) of women 60 Percent (%) provider was a family physician at the time of their hospital delivery was 8.7% overall, but much 40 higher in LHIN 14 (40.0%). • Midwives were the 20 primary care provider for 4.3% of hospital births in Ontario. 12.2% of women 0 in LHIN 14 were attended 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ON by a midwife for their hospital delivery. Obstetrician Family physician Midwife Other Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 45

Distribution of care provider who attended the hospital birth, by LHIN region of birth Ontario † , 2009 – 2010 100 • Across Ontario, the majority of women had an obstetrician attend their hospital delivery (85.4%). 80 • The proportion of women whose care Percent (%) of women 60 provider was a family physician at the time of their hospital delivery was 40 8.7% overall, and ranged from 6.2% in the GTA to 21.2% in LHINs 12–14. 20 • Midwives were the primary care provider for 4.3% of hospital births in 0 Ontario, and ranged from ESC-SW (1&2) WW-HNHB GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO 3.0% in the GTA to 7.2% in (3&4) LHINs 3&4 and LHINs 12– Obstetrician Family physician Midwife Other 14. Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 46

Fetal surveillance methods during labour, by LHIN of birth Ontario † , 2009 – 2010 • Across Ontario, the 100 majority of women Percent (%) of women who had spontaneous or induced (62.6%) received electronic fetal 80 monitoring (EFM) alone during labour. A further 26.8% of women were 60 monitored with auscultation in labour combination with EFM. 40 • The proportion of women who received auscultation alone was 20 9.1% overall, and ranged from 4.0% in LHIN 5, to 26.1% in LHIN 2. 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ON Electronic fetal monitoring only Auscultation & EFM Auscultation only No monitoring Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 47

Fetal surveillance methods during labour, by LHIN region of birth Ontario † , 2009 – 2010 • Across Ontario, the 100 majority of women (62.6%) received Percent (%) women who had spontaneous or induced electronic fetal 80 monitoring (EFM) alone during labour. A further 26.8% of women were 60 monitored with auscultation in combination with EFM. labour 40 • The regional proportion of women who received 20 auscultation alone was 9.1% overall, and ranged from 6.5% in the GTA , to 0 19.3% in LHINs 1&2. ESC-SW (1&2) WW-HNHB GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO (3&4) Electronic Fetal Monitoring only Auscultation & EFM Auscultation only No monitoring Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 48

Rate of auscultation only for fetal surveillance during labour, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 7.9 South West (2) 26.1 Waterloo Wellington (3) 11.9 HNHB (4) 7.2 Central West (5) 4.0 Mississauga Halton (6) 9.2 Toronto Central (7) 8.0 Central (8) 4.4 Central East (9) 6.2 South East (10) 5.9 Champlain (11) 11.0 North Simcoe Muskoka (12) 7.2 North East (13) 10.4 North West (14) 14.0 ONTARIO 9.1 0 5 10 15 20 25 30 Percent (%) of women who had spontaneous or induced labour Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 49

Rate of auscultation only for fetal surveillance during labour Ontario † , 2009 – 2010 30 Percent (%) of women who had spontaneous or 25 19.3 20 induced labour 15 10.2 9.7 9.1 9.0 10 6.5 5 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 50

Rate of auscultation only for fetal surveillance during labour Ontario † , 2005 – 2006 to 2009 – 2010 10 Percent (%) of women who had spontaneous or 9.3 9.3 9.1 9.1 9.1 8 induced labour 6 4 2 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 51

Rate of auscultation only for fetal surveillance during labour among low-risk women, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 15.2 South West (2) 60.8 Waterloo Wellington (3) 24.2 HNHB (4) 13.6 Central West (5) 6.9 Mississauga Halton (6) 15.8 Percent (%) Toronto Central (7) 16.4 Central (8) 7.5 Central East (9) 9.8 South East (10) 10.6 Champlain (11) 22.4 North Simcoe Muskoka (12) 14.9 North East (13) 16.8 North West (14) 27.5 ONTARIO 15.2 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Percent (%) of women who had spontaneous or induced labour Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 52

Rate of auscultation only for fetal surveillance during labour among low-risk women Ontario † , 2009 – 2010 50 Percent (%) of women who had spontaneous or 40 36.6 induced labour 30 18.4 18.3 20 17.9 15.2 10.8 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 53

Rate of auscultation only for fetal surveillance during labour among low-risk women Ontario † , 2005 – 2006 to 2009 – 2010 20 Percent (%) of women who had spontaneous or 15 15.4 15.2 15.1 14.9 14.8 induced labour 10 5 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 54

Rate of labour induction, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 33.2 South West (2) 32.8 Waterloo Wellington (3) 24.5 HNHB (4) 25.7 Central West (5) 22.5 Mississauga Halton (6) 23.8 Toronto Central (7) 24.3 Central (8) 23.1 Central East (9) 20.6 South East (10) 27.2 Champlain (11) 24.3 North Simcoe Muskoka (12) 25.4 North East (13) 29.7 North West (14) 28.1 ONTARIO 25.2 0 5 10 15 20 25 30 35 40 Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 55

Rate of labour induction Ontario † , 2009 – 2010 40 33.0 30 27.9 25.2 25.2 Percent (%) of women 25.0 23.0 20 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 56

Rate of labour induction Ontario † , 2005 – 2006 to 2009 – 2010 30 25 25.2 24.9 24.9 24.8 24.8 Percent (%) of women 20 15 10 5 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 57

Rate of labour induction among standardized nulliparous women Ontario † , 2009 – 2010 50 41.1 40 33.6 33.2 33.0 32.7 Percent (%) of women 30.6 30 20 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 58

Rate of labour induction among standardized nulliparous women Ontario † , 2005 – 2006 to 2009 – 2010 40 32.7 30 32.1 31.6 31.4 31.3 Percent (%) of women 20 10 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 59

Proportion of women who were <41 weeks of gestational age at delivery among women who were induced with a post-dates indication for induction of labour, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 18.7 South West (2) 12.1 Waterloo Wellington (3) 18.0 HNHB (4) 18.5 Central West (5) 27.5 Mississauga Halton (6) 8.2 Toronto Central (7) 9.5 Central (8) 26.4 Central East (9) 25.0 South East (10) 9.6 Champlain (11) 15.9 North Simcoe Muskoka (12) 17.8 North East (13) 30.8 North West (14) 14.2 ONTARIO 18.0 0 5 10 15 20 25 30 35 40 Percent (%) of women who had labour induction for post dates indication Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 60

Proportion of women who were <41 weeks of gestational age at delivery among women who were induced with a post-dates indication for induction of labour Ontario † , 2009 – 2010 30 Percent (%) of women who had labour induction 22.9 20 18.4 18.3 18.0 for post dates indication 14.9 13.9 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 61

Rate of assisted vaginal delivery, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 11.5 South West (2) 10.2 Waterloo Wellington (3) 11.3 HNHB (4) 11.0 Central West (5) 11.0 Mississauga Halton (6) 15.6 Toronto Central (7) 16.4 Central (8) 15.9 Central East (9) 14.3 South East (10) 13.8 Champlain (11) 14.6 North Simcoe Muskoka (12) 13.4 North East (13) 11.0 North West (14) 8.4 ONTARIO 13.6 0 5 10 15 20 Percent (%) of women who had a vaginal delivery Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 62

Rate of assisted vaginal delivery Ontario † , 2009 – 2010 20 Percent (%) of women who had a vaginal delivery 15.2 14.4 15 13.6 11.1 11.1 10.7 10 5 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 63

Rate of assisted vaginal delivery Ontario † , 2005 – 2006 to 2009 – 2010 20 Percent (%) of women who had a vaginal delivery 15 15.1 14.6 14.1 14.0 13.6 10 5 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 64

Rate of assisted vaginal delivery among standardized nulliparous women, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 21.0 South West (2) 19.8 Waterloo Wellington (3) 20.6 HNHB (4) 19.1 Central West (5) 19.8 Mississauga Halton (6) 25.9 Toronto Central (7) 25.0 Central West (8) 25.7 Central East (9) 24.5 South East (10) 24.7 Champlain (11) 24.7 North Simcoe Muskoka (12) 22.5 North East (13) 19.1 North West (14) 17.4 ONTARIO 23.0 0 10 20 30 Percent (%) of women who had a vaginal delivery Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 65

Rate of assisted vaginal delivery among standardized nulliparous women Ontario † , 2009 – 2010 30 Percent (%) of women who had a vaginal delivery 24.7 24.7 25 23.0 20.2 19.8 19.6 20 15 10 5 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 66

Rate of assisted vaginal delivery among standardized nulliparous women Ontario † , 2005 – 2006 to 2009 – 2010 30 Percent (%) of women who had a vaginal delivery 25 25.3 24.5 24.0 23.5 23.0 20 15 10 5 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 67

Rate of cesarean delivery, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 25.4 South West (2) 22.7 Waterloo Wellington (3) 25.1 HNHB (4) 28.8 Central West (5) 30.8 Mississauga Halton (6) 25.8 Toronto Central (7) 32.3 Central (8) 28.7 Central East (9) 28.7 South East (10) 28.1 Champlain (11) 29.2 North Simcoe Muskoka (12) 32.1 North East (13) 28.4 North West (14) 24.7 ONTARIO 28.3 0 10 20 30 40 Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 68

Rate of cesarean delivery Ontario † , 2009 – 2010 40 29.4 28.9 28.8 30 28.3 27.5 Percent (%) of women 23.7 20 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 69

Rate of cesarean delivery Ontario † , 2005 – 2006 to 2009 – 2010 40 30 Percent (%) of women 28.6 28.3 27.8 27.7 27.7 20 10 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 70

Proportion of women with a cesarean delivery performed prior to 39 weeks' gestation among low-risk women having an elective repeat cesarean delivery at term, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 42.0 South West (2) 44.3 Waterloo Wellington (3) 42.8 HNHB (4) 50.9 Central West (5) 64.4 Mississauga Halton (6) 55.5 Toronto Central (7) 66.2 Central (8) 66.9 Central East (9) 60.6 South East (10) 57.0 Champlain (11) 50.1 North Simcoe Muskoka (12) 45.5 North East (13) 58.8 North West (14) 55.8 ONTARIO 57.6 0 10 20 30 40 50 60 70 80 90 100 Percent (%) of low-risk women between 37-42 weeks having a repeat cesarean delivery Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 71

Proportion of women with a cesarean delivery performed prior to 39 weeks' gestation among low-risk women having an elective repeat cesarean delivery at term Ontario † , 2009 – 2010 100 Percent (%) of low-risk women between 37-42 weeks having a repeat cesarean delivery 80 63.1 57.6 60 53.1 52.6 47.9 42.9 40 20 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 72

Rate of episiotomy, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 22.0 South West (2) 10.7 Waterloo Wellington (3) 18.9 HNHB (4) 17.5 Central West (5) 14.0 Mississauga Halton (6) 14.2 Toronto Central (7) 19.8 Central (8) 29.4 Central East (9) 25.2 South East (10) 9.4 Champlain (11) 11.2 North Simcoe Muskoka (12) 20.6 North East (13) 14.7 North West (14) 6.0 ONTARIO 18.3 0 10 20 30 40 Percent (%) of women who had a vaginal birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 73

Rate of episiotomy Ontario † , 2009 – 2010 30 Percent (%) of women who had a vaginal birth 21.8 20 18.3 18.0 14.9 14.6 10.8 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 74

Rate of episiotomy Ontario † , 2005 – 2006 to 2009 – 2010 40 Percent (%) of women who had a vaginal birth 30 20 20.2* 19.7 19.5* 18.8 18.3 10 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates 75

Proportion of women with intrapartum complications Ontario†, 2009–2010 50 45.4 40 37.9 33.9 32.5 Percent (%) of women 30.5 28.4 30 20 10 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 76

Rate of pharmacologic pain management among women who had a vaginal live birth, by LHIN of birth Ontario † , 2009 – 2010 54.8 Erie St. Clair (1) Regional anesthesia • Across Ontario, 62.5% 39.8 54.2 of women who had a South West (2) Other analgesia 22.6 vaginal live birth used 57.7 Waterloo Wellington (3) 22.2 some form of regional 64.2 HNHB (4) anesthesia. 19.8% of 19.8 61.5 Central West (5) women used another 13.4 68.8 form of analgesia. Mississauga Halton (6) 7.7 76.2 Toronto Central (7) 2.1 • 76.2% of women in 70.0 Central (8) LHIN 7 used some form of 10.0 61.5 regional anesthesia; Central East (9) 19.8 55.1 however, only 2.1% of South East (10) 50.7 these women used 62.2 Champlain (11) 30.7 another form of 55.9 North Simcoe Muskoka (12) analgesia. The reverse is 33.8 43.6 North East (13) true for women who 35.2 8.7 delivered in LHIN 14 North West (14) 72.6 (8.7% used regional and 62.5 ONTARIO 19.8 72.6% used another form 0 20 40 60 80 100 of analgesia). Percent (%) of women who had a vaginal live birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 77

Rate of pharmacologic pain management among women who had a vaginal live birth Ontario † , 2009 – 2010 100 • Across Ontario, 62.5% of Percent (%) of women who had a vaginal live birth Regional anesthesia women who had a vaginal live birth used some form Other analgesia 80 of regional anesthesia. 68.8 19.8% of women used 62.5 61.7 60.4 another form of analgesia. 60 54.4 • Across the GTA 68.8% of 43.5 women used a regional 39.4 40 35.7 anesthesia; however, only 9.8% used another form of 29.0 analgesia. 20.7 19.8 20 • In the North LHINs, only 9.8 39.4% of women used a regional anesthesia; 0 however, 43.5% used ESC-SW (1&2) WW-HNHB GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO (3&4) another form of analgesia. LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 78

Rate of pharmacologic pain management among women who had a vaginal live birth Ontario † , 2005 – 2006 to 2009 – 2010 100 Regional anesthesia Percent (%) of women who had a vaginal live birth Other analgesia 80 60 62.5 61.8 61.6 61.8 59.3 40 20 21.9 21.7 21.3 21.6 19.8 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 79

Fetal mortality rate ≥ 500 grams, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 3.73 • Across Ontario, the rate of stillbirth ≥ 500 g was South West (2) 3.77 3.83 per 1,000 total Waterloo Wellington (3) 2.49 births. HNHB (4) 3.66 Central West (5) 2.12 • Variability in rates may be due to: (i) the number Mississauga Halton (6) 3.83 of Level III hospitals in a Toronto Central (7) 6.02 LHIN (there may be more Central (8) 2.77 stillbirths in these Central East (9) 3.38 hospitals as they provide care to more women with South East (10) 4.83 high ‐ risk pregnancies); (ii) Champlain (11) 3.58 small numbers (stillbirth North Simcoe Muskoka (12) 4.40 is a rare event); and (iii) North East (13) 3.18 differences between North West (14) hospitals in the complete 7.95 capture of stillbirth ONTARIO 3.83 records in the database. 0 5 10 15 20 Rate per 1,000 total births ≥ 500 grams Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 80 Error bars represent upper/lower 95% bounds

Fetal mortality rate ≥ 500 grams Ontario † , 2009 – 2010 10 • Overall, the rate of stillbirth ≥ 500 g was 3.83 Rate per 1,000 total births ≥ 500 grams per 1,000 total births. 8 • Variability in rates may be due to: (i) the number 6 of Level III hospitals in a LHIN (there may be more stillbirths in these 4 hospitals as they provide care to more women with high ‐ risk pregnancies); (ii) 2 small numbers (stillbirth is a rare event); and (iii) 3.75 3.22 3.88 3.88 4.65 3.83 differences between 0 hospitals in the complete ESC-SW (1&2) WW-HNHB GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO (3&4) capture of stillbirth records in the database. LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 81 Error bars represent upper/lower 95% bounds

Rate of preterm birth (<37 weeks), by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 7.4 South West (2) 8.8 Waterloo Wellington (3) 6.0 HNHB (4) 8.5 Central West (5) 7.9 Mississauga Halton (6) 6.4 Toronto Central (7) 11.4 Central (8) 6.7 Central East (9) 6.9 South East (10) 9.2 Champlain (11) 9.5 North Simcoe Muskoka (12) 7.3 North East (13) 7.6 North West (14) 6.3 ONTARIO 8.2 0 5 10 15 Percent (%) of live births Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 82

Rate of preterm birth (<37 weeks) Ontario † , 2009–2010 10 9.5 8.3 8.2 8.0 8 7.6 7.3 Percent (%) of live births 6 4 2 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 83

Rate of preterm birth (<37 weeks) Ontario†, 2005–2006 to 2009–2010 10 8 8.3 8.2 8.2 8.2 8.2 Percent (%) of live births 6 4 2 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 84

Rate of small for gestational age, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 8.2 South West (2) 8.0 Waterloo Wellington (3) 7.4 HNHB (4) 7.1 Central West (5) 12.2 Mississauga Halton (6) 10.6 Toronto Central (7) 9.9 Central (8) 10.2 Central East (9) 10.4 7.2 South East (10) Champlain (11) 7.4 North Simcoe Muskoka (12) 7.7 North East (13) 7.4 North West (14) 5.9 ONTARIO 9.0 0 5 10 15 20 Percent (%) of singleton live births Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 85

Rate of small for gestational age Ontario†, 2009–2010 20 Percent (%) of singleton live births 15 10.5 10 9.0 8.1 7.3 7.2 7.2 5 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 86

Rate of large for gestational age, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 10.8 South West (2) 12.8 Waterloo Wellington (3) 11.2 HNHB (4) 12.3 Central West (5) 7.4 Mississauga Halton (6) 8.9 Toronto Central (7) 8.7 Central (8) 8.4 Central East (9) 9.8 South East (10) 12.2 Champlain (11) 12.1 North Simcoe Muskoka (12) 11.2 North East (13) 13.3 North West (14) 17.0 ONTARIO 10.4 0 5 10 15 20 25 30 Percent (%) of singleton live births Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 87

Rate of large for gestational age Ontario†, 2009–2010 20 Percent (%) of singleton live births 15 13.4 12.1 12.0 11.9 10.4 10 8.7 5 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 88

Rate of multiple birth, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 3.0 South West (2) 3.5 Waterloo Wellington (3) 3.1 HNHB (4) 3.7 Central West (5) 3.3 Mississauga Halton (6) 3.0 Toronto Central (7) 5.7 Central (8) 3.1 Central East (9) 2.7 South East (10) 3.8 Champlain (11) 4.1 North Simcoe Muskoka (12) 3.4 North East (13) 2.9 North West (14) 2.8 ONTARIO 3.6 0 2 4 6 8 10 Percent (%) of total births Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 89

Rate of multiple birth Ontario † , 2009 – 2010 5 4.0 4 3.7 3.6 3.4 Percent (%) of live births 3.3 3.0 3 2 1 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 90

Rate of multiple birth Ontario † , 2005 – 2006 to 2009 – 2010 5 4 Percent (%) of live births 3.6 3.5 3.5 3.4 3.4 3 2 1 0 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Fiscal year Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only 91

Section V Postpartum and newborn 92

Proportion of live births with a 5-minute Apgar score <7, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 1.1 South West (2) 2.2 Waterloo Wellington (3) 1.3 HNHB (4) 1.3 Central West (5) 1.1 Mississauga Halton (6) 0.8 Toronto Central (7) 1.3 Central (8) 1.0 Central East (9) 1.2 South East (10) 2.5 Champlain (11) 2.0 North Simcoe Muskoka (12) 1.5 North East (13) 1.6 North West (14) 2.1 ONTARIO 1.4 0 1 2 3 4 5 Percent (%) of live births Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 93

Proportion of live births with a 5-minute Apgar score <7 Ontario † , 2009 – 2010 5 4 Percent(%) of live births 3 2.1 2 1.8 1.7 1.4 1.4 1.1 1 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 94

Rate of exclusive breastfeeding at discharge among term live births, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 45.3 South West (2) 59.4 Waterloo Wellington (3) 70.9 HNHB (4) 58.0* Central West (5) 37.8 Mississauga Halton (6) 63.1 Toronto Central (7) 69.3 § Central (8) 59.6 Central East (9) 54.3 § South East (10) 56.4 Champlain (11) 64.9 North Simcoe Muskoka (12) 72.8 North East (13) 61.3 North West (14) 57.6 ONTARIO 59.8 § 0 20 40 60 80 100 Percent (%) of term live births Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates 95 § Individual hospital sites that do not collect information on breastfeeding at discharge from hospital, or that have >30% of records with missing information on this variable have been excluded from the denominator used for these calculations.

Rate of exclusive breastfeeding at discharge among term live births Ontario † , 2009 – 2010 100 80 Percent (%) of term live births 64.4 63.3* 62.4 59.8 § 58.9 § 60 54.0 40 20 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of birth Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates 96 § Individual hospital sites that do not collect information on breastfeeding at discharge from hospital, or that have >30% of records with missing information on this variable have been excluded from the denominator used for these calculations.

Section VI Maternal and newborn screening 97

Ratio of maternal multiple marker screening, by LHIN of residence Ontario † , 2009 – 2010 Erie St. Clair (1) 34.1 South West (2) 46.3 Waterloo Wellington (3) 48.2 HNHB (4) 45.2 Central West (5) 64.2 Mississauga Halton (6) 63.5 Toronto Central (7) 85.7 Central (8) 77.1 Central East (9) 67.6 South East (10) 54.1 Champlain (11) 65.3 North Simcoe Muskoka (12) 45.6 North East (13) 30.6 North West (14) 26.6 ONTARIO 66.9 0 20 40 60 80 100 Screening ratio (%) Source – BORN Ontario (Ontario Maternal Multiple Marker Screening Program Database and Niday Perinatal Database), 2009–2010 † Ontario residents only 98

Ratio of maternal multiple marker screening Ontario † , 2009 – 2010 100 80 72.2 66.9 62.4 Screening ratio (%) 60 46.4 41.5 40 34.9 20 0 ESC-SW (1&2) WW-HNHB (3&4) GTA (5 − 9) SEC (10&11) North (12 − 14) ONTARIO LHIN region of residence Source – BORN Ontario (Ontario Maternal Multiple Marker Screening Program Database and Niday Perinatal Database), 2009–2010 † Ontario residents only 99

Proportion of women who were screened for Group B Streptococcus among women who delivered at ≥ 37 weeks, by LHIN of birth Ontario † , 2009 – 2010 Erie St. Clair (1) 97.0 South West (2) 92.1 Waterloo Wellington (3) 90.3 HNHB (4) 88.6* Central West (5) 99.2* Mississauga Halton (6) 91.8 Toronto Central (7) 94.1 Central (8) 95.3 Central East (9) 95.6 South East (10) 91.0 Champlain (11) 94.8* North Simcoe Muskoka (12) 88.4 North East (13) 89.9 North West (14) 88.1 93.3 ONTARIO 0 20 40 60 80 100 Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only 100 * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates