Obstetric maternal outcomes at Bella Coola General Hospital: 1940 to 2001.

OBJECTIVE To describe obstetric procedures (episiotomy, forceps, vacuum extraction, caesarean section) and maternal outcomes for patients who gave birth in an isolated, rural hospital. DESIGN A retrospective cohort study. STUDY POPULATION Women beyond 20 weeks' gestation who gave birth between Mar. 7, 1940, and June 9, 2001, inclusive, at the Bella Coola General Hospital (BCGH). MAIN OUTCOME MEASURES Data collected included maternal age, date of delivery, mode of delivery (vaginal delivery v. cesarean section), whether an episiotomy was performed or not, if forceps or vacuum extraction were used, whether analgesia, sedation or anesthesia was used, and maternal mortality. RESULTS There were 2373 deliveries, including 12 sets of twins. There were no maternal mortalities. Cesarean sections were not routinely performed until the 1970s. Since then, there has been an increase in cesarean section rates to 11% of all deliveries in the 1990s. In the 1940s 28% of deliveries involved an episiotomy. This increased to 47% in the 1970s and was followed by a sharp decline to 4% in the 1990s. There was an increase, followed by a more gradual decrease in the use of forceps, and there was a recent increase in the use of vacuum extraction. The changes in procedure rates appear to reflect best practice guidelines of the times. In the case of episiotomies, the data suggest rural physicians are capable of rapid incorporation of recent recommendations. Rates for all procedures tended to be lower than those reported elsewhere in Canada and the United States. Narcotics, sedatives, inhalation agents and regional anesthetics were used to relieve the pain of labour and delivery throughout the study period. CONCLUSIONS Women giving birth in the low technology environment of the BCGH experienced relatively low obstetric procedural rates with excellent maternal outcomes.