Canadian Perinatal Health Report - 2008 EDITION

KEY FINDINGS

FACTSHEET - DECEMBER 2008

The Canadian Perinatal Health Report, 2008 Edition, includes the following key findings (based on data up to the year 2005):

• The number of babies born to teenage mothers decreased steadily between 1995 and 2004.  At the same time, there has been an increasing trend towards delayed childbearing – more babies are being born to women aged 35 and older.

• More and more new mothers are starting breastfeeding when their baby is born – 87% of recent mothers surveyed in 2005.  However, the proportion of mothers who breastfeed declines as the baby gets older, with only 16% of mothers reporting exclusive breastfeeding at 6 months of baby’s age in 2005.

• Overall, pregnant women and new mothers in Canada are increasingly educated, and pregnant women are smoking less and reporting less exposure to second hand smoke than in years past.  In 2000, 18% of women reported smoking during their pregnancy, compared to 13% in 2005.  Also, there has been a slight decrease in women’s alcohol use during pregnancy (from 12% of pregnant women in 2000 to 11% in 2005). This is good news, but these issues continue to be important public health concerns, given their impact on the health of pregnant women and their babies.

• The proportion of babies delivered by cesarean continues to increase in Canada.  In 2004-2005, 25.6% of hospital deliveries were cesarean deliveries, compared to 17.6% in 1995-1996. The trend towards older mothers, increase in proportion of births that are first births, and rise of obesity in the population may partially explain the rise in cesarean delivery, as each of these factors increases the likelihood of cesarean. Changes in medical practice, such as greater use of electronic monitoring of the fetus and cesarean delivery for breech may also be affecting the rate of cesarean delivery.

• The national episiotomy rate has declined dramatically in the past decade. An episiotomy is a surgical incision made at the vaginal opening during birth, to assist in delivery of the baby.  In 1995-1996, 31.1 episiotomies were performed per 100 hospital vaginal deliveries, and 20.4 per 100 were performed in 2004-2005 – a 34% decrease.  This reduction in episiotomies is likely due to the use of evidence-based recommendations from organizations such as the World Health Organization, which recommend against routine episiotomy.

• Maternal mortality in Canada – the number of women who die during or shortly after a pregnancy, because of the pregnancy – is among the lowest in the world.  Canada’s maternal mortality ratio has fluctuated since 1981 from a low of 3.4 deaths per 100,000 live births in 1984-1986 to a more recent high of 5.5 per 100,000 live births in 2002-2004.  While this variation may be a statistical effect because of the small number of deaths overall, maternal mortality requires further study, and this is underway. 

• Severe maternal morbidity – the very serious, life-threatening illness of a pregnant woman or new mother – is also an important health issue that requires further attention.  This includes the rise in postpartum hemorrhage, or severe bleeding after birth, that has been seen in several countries.  This is the subject of international discussions by maternal health researchers, including representatives from Canada.

• Infant mortality continues to decrease in Canada, with a rate of 5.1 infant deaths per 1,000 live births in 2004.  A decline in infant deaths due to congenital anomalies, also known as birth defects, and a decline in deaths due to Sudden Infant Death Syndrome (SIDS) are contributing to this overall decrease.  In 2004, immaturity (due to preterm birth) was the leading cause of infant death in Canada.

• More and more babies are being born prematurely in Canada, with a rate of 8.2 preterm births per 100 live births in 2004, compared to 7.0 per 100 in 1995. Older maternal age, more multiple births (twins, triplets, etc) and an increase in early delivery for medical reasons are believed to be the main reasons for this increase.  The causes of preterm birth in general are complex and not well understood, and may include biological and medical factors, genetics and psychosocial factors such as stress.  Babies born preterm have an increased risk of illness or death in infancy and of childhood developmental problems.

• Multiple births have increased from 2.2 per 100 total births in 1995 to 3.0 per 100 total births in 2004.  Older mothers are more likely to have a multiple pregnancy, as are women who use fertility treatments and assisted reproductive technologies such as in vitro fertilization.  These two factors appear to be the main reasons for the increase in multiple births in Canada. 

The full text of the Canadian Perinatal Health Report, 2008 Edition, including a summary section entitled “An Overview of Perinatal Health in Canada”, is available on-line at www.publichealth.gc.ca/cphr .