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.