Literature / Littérature scientifique [CJRM

Literature / Littérature scientifique

CJRM 1999;4(4):244.

This issue's column focuses on rural obstetrics, both in Canada and internationally.

Provision of intrapartum care by GP/FPs in Canada: an update. Levitt C, Kaczorowski J. CMAJ 1999;160(6):815-6.

In this article Drs. Levitt and Kaczorowski, from McMaster University, report on the trends of

involvement of GP/FPs with obstetrical care in Canada. The data are derived from fee-for-service billing data from the National Physician Database housed by CIHI and suggest that between 1984 and 1994 the proportion of total vaginal deliveries billed by GP/FPs declined from 54.8% to 45.0%. This represented an absolute decline of 22000
deliveries over the 11-year period. The authors state that "This decline probably reflects the decreased involvement of GP/FPs in the provision of intrapartum care in Canada." They also noted that this trend has particular significance in rural areas. "This shortage of human resources for obstetric care is already being felt in many rural areas of the US and Canada, where women must travel great distances and be separated from their families when they give birth."

Trends in small hospital obstetrics services in Ontario. Rourke JT. Can Fam Physician 1998;44 (10):2117-24.

This article, focussing on rural hospitals in Ontario over a roughly comparable period (1988 to 1995), repeated a survey done in 1988 to compare the change in
obstetric services provided in small Ontario hospitals over the 12-year span. Thirty-five hospitals were surveyed, and the au-
thor reported that this group of hospitals had "significantly fewer births, fewer family physicians attending births, and fewer GP anaesthetists in 1995 than in 1988." He also noted that "11 other hospitals that had provided active obstetric care in 1988 (defined as more than 25 births yearly), no longer did so in 1995."

Obstetrics anyone? How family medicine residents' interests changed. Ruderman J. Can Fam Physician 1999;45(3):638-40, 643-7.

This study covers a 5-year period from 1991 to 1996 during which the attitudes of 4 consecutive family medicine resident cohorts were tracked with respect to their "attitudes and plans about practising obstetrics.when they graduated." Two hundred and fifteen residents completed both entry and exit questionnaires. Results showed that although women had a greater interest in obstetrics both at entry and at exit, both men and women demonstrated a decrease in their interest by the time they graduated, (58% at entry and 49% at exit for women, and 31% at entry and 22% at exit for men). The study identified perceived lifestyle factors and compensation as "very important negative factors." The authors also concluded that the "intent to practise obstetrics after graduation was most closely linked to being a woman, intending to practise in a rural area, and having an interest in obstetrics prior to residency."

Outcomes in rural obstetrics, Atherton Hospital 19811990. Cameron B. Aust J Rural Health 1998;6(1):46-51.

Although lifestyle and compensation are significant barriers in the choice of taking up rural obstetrics, risk and liability also remain a concern in the minds of planners and practitioners alike. In this article, the author reports on audit data collected in far north Queensland in Australia over a 10-year period from 1981 to 1990. Over this period, "there were 2883 deliveries with an overall perinatal mortality of 5.2/1000." Even when the results were corrected for deaths occurring within the population, transferred because of complications such as prematurity or neonatal problems, the rates compared favourably with the overall rates for Queensland and the Far North Statistical Division which were 13.5/1000 and 16.9/1000 respectively.