Does having cesarean section capability make a difference to a small rural maternity service?

OBJECTIVE To determine whether having cesarean section capability in an isolated rural community makes a difference in adverse maternal or perinatal outcomes. DESIGN Retrospective study comparing population-based obstetric outcomes of two rural remote hospitals in northwestern British Columbia. One hospital had cesarean section capability; one did not. SETTING Bella Coola General Hospital (with cesarean section capability) in Bella Coola Valley (BCV) and Queen Charlotte Islands General Hospital (without cesarean section capability) in Queen Charlotte City (QCC). PARTICIPANTS Women who carried pregnancies beyond 20 weeks' gestation and who gave birth between January 1, 1986, and December 31, 2000. INTERVENTIONS British Columbia Vital Statistics Agency data was used to compare obstetric outcomes in the two communities. A chart audit of local births at BCV and QCC was done to validate the vital statistics data. MAIN OUTCOME MEASURES Perinatal death, newborn transfer to a tertiary care facility, birth weight, gestational age at delivery, mode of delivery, and Apgar score. RESULTS The rate of preterm deliveries in QCC was higher (relative risk 1.41, 95% confidence interval 1.00 to 1.99; P = .047) than the rate in BCV. Otherwise, there were no differences in adverse maternal or perinatal outcomes in the two populations. In BCV, 69.8% of women delivered locally compared with 50.2% of women in the southern Queen Charlotte Islands (P < .001). CONCLUSION Having local cesarean section capability is associated with a greater proportion of local deliveries and a lower rate of preterm deliveries.