Indicators for Prenatal Support and Neonatal Outcomes in Northern Canada
Denning, Bryany Beth Ingleton
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Background: The current practice in northern Canada is to transfer pregnant women residing in communities without hospital facilities to larger centres at 37 weeks gestation. Little research has been conducted on how the practice of transferring women for childbirth affects available prenatal care continuity and prenatal care options, and whether or not this in turn affects health outcomes. Objectives: The aim of this study is to examine whether differences exist in prenatal care, risk factor distribution, and neonatal morbidity, between women who are transferred for childbirth, and women who are able to remain in their home community to give birth. Methods: Secondary analysis of the Canadian Maternity Experiences Survey 2006-2007 data was conducted in order to examine the relationship between transfer for childbirth, prenatal care, maternal risk factors, and neonatal morbidity. Crude odds ratios and adjusted odds ratios were calculated to assess the relationships between variables using multiple logistic regression, with bootstrap weights applied. Results: Women who were transferred for childbirth were more likely to experience a negative neonatal morbidity outcome (OR=1.9, 95% CIs 1.3-2.8), though this relationship disappeared when the relationship was adjusted for potential confounders. When these results were adjusted for potential confounding, smoking during pregnancy was the only risk factor shown to be significantly associated with neonatal morbidity in this study (OR=1.8, 95% CIs 1.0-3.0). Conclusion: More detailed and widespread data collection is needed to be able to properly assess prenatal care, maternal risk factors and neonatal morbidity in northern Canada. A perinatal database, constructed for surveillance purposes, would assist in further exploring the effect of transfer policy on prenatal care practices and maternal risk factor distribution, and the effect this has on neonatal health outcomes.