Mothers-to-be in rural and remote parts of Canada face a different experience than their urban counterparts when they are giving birth, with longer trips to hospital and less access to the specialist doctors that women in urban centres might see.
But despite that, the outcomes in terms of their health and their babies' health does not seem to be substantially different, says a new report from the Canadian Institute for Health Information (CIHI).
Women from remote and rural communities are 28 times more likely to travel more than two hours to give birth, and if they need to deliver by cesarean section they are 13 times more likely to have the operation performed by a family doctor or a general surgeon than by an obstetrician or a gynecologist, the report shows.
But they appear to be slightly less likely to deliver by c-section, and are more likely to have a spontaneous vaginal birth.
The findings were generated from a CIHI analysis of five years' worth of data on women delivering babies in remote and rural areas. The aim, said a CIHI executive, is to give health authorities a picture of the experiences women from these parts of Canada face when giving birth.
"We've given the health authorities some basic data and that will allow them to look at their own experiences and to possibly talk to other health authorities similar to them and say, 'How do your outcomes differ from ours?'" says Anne McFarlane, the vice-president of the western office and development initiatives for CIHI.
"It's hard for rural health authorities to get data, because … the numbers are smaller than they are in an urban centre."
Nationally, the overall number of babies born in Canadian hospitals has been relatively stable for the past five years. Almost 373,000 infants were born in hospital in 2011-2012, representing a slight increase since 2010-2011. During the same period, the rate of Canadian women who had a c-section for the first time also remained relatively stable at 17.9 per cent, though with variation from province to province. The rate of babies born preterm in 2011-2012 was 8 per cent, a figure that has been relatively stable for six years.
The report found that there were 242,550 in-hospital deliveries for women from rural and remote areas during the five-year period, representing 18 per cent of all hospital deliveries in the country. The period studied in the report ran from 2007 to 2012. The report looked at births in all parts of Canada except Quebec, which declined to take part in the study.
As of 2011, 19 per cent of Canadians lived in a rural area, defined by Statistics Canada as a community of 10,000 or fewer.
"That's not absolutely huge, but when you think of 242,000 babies being born over five years, that's a lot of babies and a lot of services," says McFarlane, who added that the diversity of necessary obstetrical services and the unpredictability of birth dates provide extra challenges for rural care providers.
Those varying needs reflect the fact that 67 per cent of rural women give birth in urban hospitals, the CIHI report says. As a result, 17 per cent of women from rural and remote communities had to travel more than two hours to deliver their babies.
An October, 2012, position paper by the Society of Obstetricians and Gynecologists of Canada argued that women shouldn't have to travel long distances to give birth, saying that having access to services locally leads to better outcomes.
"[Travelling to an urban centre] is an imposition on them, and on their families, and the psychological and emotional stress of having to travel, of leaving your other kids, all the little things we find joyous about having babies – for a lot of rural women it's more stressful for them," McFarlane says.
However, while the access to care for women may be different, the outcomes proved surprisingly similar. For rural women, severe health issues and unplanned rehospitalizations were only slightly more common.
"The differences weren't huge, and that was interesting and reassuring, in the sense that you think, 'These two systems are planned differently, but they seem to be working relatively similarly for outcomes,'" says McFarlane.
"One of the things we see clearly is there is a system of care, and the system of care for rural women includes both rural and urban hospitals because you may need to be transferred to an urban hospital."