title: Does having cesarean section capability make a difference to a small rural maternity service?
abstract: OBJECTIVE
  To determine whether having cesarean section capability in an isolated rural community makes a difference in adverse maternal or perinatal outcomes.
  
  
  METHODS
  Retrospective study comparing population-based obstetric outcomes of two rural remote hospitals in northwestern British Columbia. One hospital had cesarean section capability; one did not.
  
  
  METHODS
  Bella Coola General Hospital (with cesarean section capability) in Bella Coola Valley (BCV) and Queen Charlotte Islands General Hospital (without cesarean section capability) in Queen Charlotte City (QCC).
  
  
  METHODS
  Women who carried pregnancies beyond 20 weeks' gestation and who gave birth between January 1, 1986, and December 31, 2000.
  
  
  METHODS
  British Columbia Vital Statistics Agency data was used to compare obstetric outcomes in the two communities. A chart audit of local births at BCV and QCC was done to validate the vital statistics data.
  
  
  METHODS
  Perinatal death, newborn transfer to a tertiary care facility, birth weight, gestational age at delivery, mode of delivery, and Apgar score.
  
  
  RESULTS
  The rate of preterm deliveries in QCC was higher (relative risk 1.41, 95% confidence interval 1.00 to 1.99; P = .047) than the rate in BCV. Otherwise, there were no differences in adverse maternal or perinatal outcomes in the two populations. In BCV, 69.8% of women delivered locally compared with 50.2% of women in the southern Queen Charlotte Islands (P < .001).
  
  
  CONCLUSIONS
  Having local cesarean section capability is associated with a greater proportion of local deliveries and a lower rate of preterm deliveries.
authors.affiliation: Nursing Program, Prince George, BC.
authors.forename: Nancy
authors.initials: N
authors.lastname: Lynch
authors.forename: Harvey
authors.initials: H
authors.lastname: Thommasen
authors.forename: Nancy
authors.initials: N
authors.lastname: Anderson
authors.forename: Stefan
authors.initials: S
authors.lastname: Grzybowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001955:British Columbia; D002585:Cesarean Section; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards*