Maternity Services and Policy in an International Context: Risk, Citizenship and Welfare Regimes by Patricia Kennedy & Naonori Kodate

Author:Patricia Kennedy & Naonori Kodate [Kennedy, Patricia & Kodate, Naonori]
Language: eng
Format: epub
Tags: Medical, Nursing, Maternity; Perinatal; Women's Health, Political Science, Public Policy, Social Policy
ISBN: 9780415738941
Google: zLV1oAEACAAJ
Goodreads: 22869526
Publisher: Routledge
Published: 2015-01-15T11:09:05+00:00

Intrapartum care

Canada has historically had low infant and maternal mortality rates, but has lost ground in recent years compared with other developed nations. In 1990, Canada ranked fifth among peer countries, but most recently it has had the second highest infant mortality rate, only performing better than the USA (OECD 2013). In 2009, Canada’s infant mortality rate was 5.1 deaths per 1,000 live births, above the OECD average of 4.4 deaths per 1,000 live births. Both infant and maternal mortality have been increasing in Canada since the mid-1990s and low income infants are particularly vulnerable (Lisonkova et al. 2011; Society of Obstetricians and Gynaecologists of Canada 2008b; Wilkins et al. 2000; WHO 2010). In 2009, 6.0 per cent of babies in Canada had a low birthweight (< 2,500 g), which is better than the OECD average of 6.7 per cent in 2009 and ranks twelfth among thirty-nine OECD countries (OECD 2011). However, the percentage of babies with low birthweight in Canada increased from 1980 to 2009 as a result of several common changes in Western nations: women giving birth at older ages, more multiple births and increases in the induction of labour and caesarean deliveries of premature or late preterm infants (OECD 2011).

For maternal mortality, Canada currently ranks thirty-fifth in the world, with twelve deaths for every 100,000 live births – a considerably lower rate than in the USA (WHO 2010). However, Canada has slipped from second to eleventh place in the world ranking among the OECD countries since 1990. Maternal morbidity, which refers to illness or injury arising from complications of pregnancy or delivery, has also been increasing in Canada over the last two decades (Wen et al. 2004). Examples of maternal morbidity include gestational diabetes, pre-eclampsia and haemorrhage; examples of severe morbidity include peripartum hysterectomy, renal failure, heart failure, stroke, pulmonary embolism and septic shock. Some maternal complications are a leading cause of neonatal mortality and morbidity. Table 7.3 gives Canada’s maternal and neonatal mortality statistics from 1970 to 2010.

Canada’s Western medical tradition includes a culture of birth that normalises medical interventions. Almost half of all vaginal births (47.9 per cent) occurred from a supine position (with the mother lying on her back), while 45.8 per cent of women were propped up, even though Health Canada recommends that women receive information about various birth positions so that they can make an informed choice about their preferred position (PHAC 2009). The supine position, although common in Western medical practice, is among the least desirable physiologically.

Epidural analgesia, induction and stimulation with Pitocin, and continuous electronic foetal monitoring are extremely common. Table 7.3 gives Canada’s rates for some of these procedures over time, showing that the rates of induction and caesarean delivery have risen, while episiotomy rates have declined. Induction is ‘the artificial initiation of labour before its spontaneous onset’ and Health Canada recommends induction only ‘when the risk of continuing pregnancy is greater than the risk of induction’ (Health Canada 2000). However, in 2004–2005, 28.1 per cent of deliveries in Canada were artificially induced (PHAC 2009).

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