title: Use of routine interventions in labour and birth in Canadian hospitals: comparing results of the 1993 and 2007 Canadian hospital maternity policies and practices surveys.
abstract: OBJECTIVE
  To compare policies and practices of routine interventions in labour and birth in Canadian hospitals in 1993 and 2007 and to describe trends regarding adherence to evidence-based guidelines.
  
  
  METHODS
  We used data from surveys of Canadian hospitals in 1993 and 2007 on routine maternity care practices and policies, including interventions in labour and birth.
  
  
  RESULTS
  The response rate of hospitals in 1993 was 91% (523/572), and in 2007 it was 92% (323/353). In 1993, 65% of hospitals (335/516) had a policy that all women should have initial electronic fetal heart rate monitoring, and in 2007, 74% (235/319) had such a policy. In 1993, 55% of hospitals (284/516) used epidural anaesthesia as one of the methods for pain control, and in 2007, 87% of hospitals (278/318) did so. In 1993, 37% of hospitals (193/521) had a "no enema/suppository" policy on admission, and in 2007, 88% (282/322) did. In 1993, 87% of hospitals (450/516) had a policy encouraging the presence of both the woman's partner and other labour support people in the room during the course of labour; in 2007, 80% (259/323) did. In 1993, hospitals estimated that 62% of primiparous women and 44% of multiparous women had an episiotomy in their units. In 2007, the episiotomy rate, irrespective of parity, was 17%. In 1993, 20% of hospitals (98/498) had a policy specifying the length of the second stage of labour, and in 2007, 33% (101/307) had such a policy.
  
  
  CONCLUSIONS
  Positive and negative trends in adherence to best practices were seen in policies and practices of routine interventions during labour and birth in Canadian hospitals between 1993 and 2007.
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, ON.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Levitt
authors.affiliation: Canadian Institute of Child Health, Ottawa, ON.
authors.forename: Louise
authors.initials: L
authors.lastname: Hanvey
authors.affiliation: Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, ON.
authors.forename: Sharon
authors.initials: S
authors.lastname: Bartholomew
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver, BC.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON.
authors.forename: Beverley
authors.initials: B
authors.lastname: Chalmers
authors.affiliation: Faculty of Nursing, University of Manitoba, Winnipeg, MA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, ON.
authors.forename: Xiaoke
authors.initials: X
authors.lastname: Li
mesh_terms: D000773:Anesthesia, Obstetrical / Q000706:statistics & numerical data; D002170:Canada; D036861:Delivery, Obstetric / Q000379:methods*; D004733:Enema; D004841:Episiotomy / Q000706:statistics & numerical data; D055317:Evidence-Based Practice; D005260:Female; D005323:Fetal Monitoring / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006340:Heart Rate, Fetal; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007743:Labor, Obstetric; D008427:Maternal Health Services / Q000379:methods / Q000592:standards* / Q000639:trends*; D057766:Policy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D013997:Time Factors