Highlights from the BORN Ontario LHIN Region Reports for 2009 2010 - - PowerPoint PPT Presentation

Highlights from the BORN Ontario LHIN Region Reports for 2009−2010

August 2011

2

Introduction

Report objectives:

• Illustrate the utility of data in supporting indicators that are

relevant to maternal‐newborn care and provision of

• bstetrical health services
• Highlight maternal‐newborn issues and trends arising from the

analysis

• Present a baseline for future examination of trends

3

Introduction

Methods:

• Unless otherwise noted, data presented in the reports originate

from the BORN–Niday Perinatal Database, 2009–2010

• Time trends are provided for selected indicators (2005–2006 to

2009–2010)

• Only hospital births to Ontario residents were included
• Hospital births attended by midwives are included in these

analyses

• Unless otherwise noted, analysis is by LHIN of birth (i.e., where

the hospital birth occurred, regardless of maternal residence)

4

Introduction

Notes:

• Definitions for each indicator and footnotes regarding the

calculation of each indicator are provided in the body of the report underneath each figure

• Records that were missing information for a particular

indicator were excluded from analyses of that indicator

– Footnotes have been added to figures to alert the reader when more than 10% but less than 30% of records for a particular estimate were missing information – Due to validity concerns, we excluded estimates for which ≥30% of records were missing information for that indicator

LHIN region LHINs

ESC‐SW (1&2) Erie St. Clair (1) South West (2) WW‐HNHB (3&4) Waterloo Wellington (3) Hamilton Niagara Haldimand Brant (4) GTA (5–9) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) SEC (10&11) South East (10) Champlain (11) North (12–14) North Simcoe Muskoka (12) North East (13) North West (14)

5

Ontario Local Health Integration Networks

6

Ontario Local Health Integration Networks

7

Where to find the reports

• All 5 LHIN region reports are available online

www.bornontario.ca

Indicators

8

Section I ‐ Profile of obstetrical population

• Distribution of hospital births
• Number of women in midwifery care that gave birth at home
• Distribution of maternal age
• Distribution of parity
• Proportion of women who were ≥35 years and nulliparous at delivery

Section II ‐ Pregnancy

• Proportion of women who did not attend an antenatal visit with a health care provider during

the first trimester

• Proportion of women with pre‐existing health conditions
• Proportion of women with obstetrical complications
• Rate of assisted conception

Section III ‐ Maternity health services

• Distribution of births at each level of care
• Distribution of live births at each level of care, by gestational age at birth

Indicators

9

Section IV ‐ Birth

• Distribution of care provider who attended the hospital birth
• Fetal surveillance methods during labour
• Rate of auscultation only for fetal surveillance during labour
• Rate of labour induction
• Proportion of women who were <41 weeks of gestational age at delivery among women who

were induced with a post‐dates indication for induction of labour

• Rate of assisted vaginal delivery
• Rate of cesarean delivery
• Proportion of women with a cesarean delivery performed prior to 39 weeks' gestation among

low‐risk women having an elective repeat cesarean delivery at term

• Rate of episiotomy
• Proportion of women with intrapartum complications
• Rate of pharmacologic pain management among women who had a vaginal live birth
• Length of second stage of labour among women with a vaginal birth
• Fetal mortality rate ≥500 grams
• Rate of preterm birth
• Rate of small for gestational age
• Rate of large for gestational age
• Rate of multiple birth

Indicators

10

Section V ‐ Postpartum and newborn

• Proportion of live births with a 5‐minute Apgar score <7
• Rate of exclusive breastfeeding at discharge among term live births

Section VI ‐ Maternal and newborn screening

• Ratio of maternal multiple marker screening
• Proportion of women who were screened for Group B Streptococcus among women who

delivered at ≥37 weeks of gestation

• Number of infants with newborn screening completed and proportion who screen positive
• Ratio of Parkyn screen completion

Section I Profile of obstetrical population

11

12

Number of total hospital births, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

Number of hospital births LHI N of birth Erie St. Clair (1) 6,180 South West (2) 10,114 Waterloo Wellington (3) 7,631 HNHB (4) 12,884 Central West (5) 8,041 Mississauga Halton (6) 12,845 Toronto Central (7) 19,871 Central (8) 18,453 Central East (9) 13,959 South East (10) 4,152 Champlain (11) 13,199 North Simcoe Muskoka (12) 3,880 North East (13) 5,040 North West (14) 2,526 ONTARI O 138,775

13

Percent (%)

Distribution of hospital births, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

4.5 7.3 5.5 9.3 5.8 9.3 14.3 13.3 10.1 3.0 9.5 2.8 3.6 1.8 5 10 15 20 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14)

Percent (%) of hospital births

14

Number of total hospital births, by LHIN region

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

Number of hospital births LHI N region

• f birth

ESC-SW (1&2) 16,294 WW-HNHB (3&4) 20,515 GTA (5−9) 73,169 SEC (10&11) 17,351 North (12−14) 11,446 ONTARI O 138,775

15

Percent (%)

Distribution of hospital births

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

11.7 14.8 52.7 12.5 8.2 15 30 45 60 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14)

Percent (%) of hospital births

16

Number of women in midwifery care that gave birth at home, by LHIN of maternal residence

Ontario†, 2009–2010

Source – Ontario Midwifery Program Maternal‐Newborn Health Reporting System (Ontario MOHLTC), 2009–2010 † Ontario residents only

Number of women LHI N of maternal residence Erie St. Clair (1) 60 South West (2) 292 Waterloo Wellington (3) 325 HNHB (4) 369 Central West (5) 39 Mississauga Halton (6) 95 Toronto Central (7) 430 Central (8) 163 Central East (9) 240 South East (10) 111 Champlain (11) 311 North Simcoe Muskoka (12) 110 North East (13) 95 North West (14) 37 ONTARI O 2,677

17

Distribution of women in midwifery care that gave birth at home, by LHIN of maternal residence

Ontario†, 2009–2010

2.2 10.9 12.1 13.8 1.5 3.5 16.1 6.1 9.0 4.1 11.6 4.1 3.5 1.4 5 10 15 20 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14)

Percent (%) of women in midwifery care who had a home birth Source – Ontario Midwifery Program Maternal‐Newborn Health Reporting System (Ontario MOHLTC), 2009–2010 † Ontario residents only

18

Number of women in midwifery care that gave birth at home, by LHIN region of maternal residence

Ontario†, 2009–2010

Source – Ontario Midwifery Program Maternal‐Newborn Health Reporting System (Ontario MOHLTC), 2009–2010 † Ontario residents only

Number of women LHI N region

• f maternal

residence ESC-SW (1&2) 352 WW-HNHB (3&4) 694 GTA (5−9) 967 SEC (10&11) 422 North (12−14) 242 ONTARI O 2,677

19

Distribution of women in midwifery care that gave birth at home, by LHIN region of maternal residence

Ontario†, 2009–2010

LHIN region of maternal residence

Source – Ontario Midwifery Program Maternal‐Newborn Health Reporting System (Ontario MOHLTC), 2009–2010 † Ontario residents only

13.0 25.6 35.7 15.6 8.9 10 20 30 40 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14)

Percent (%) of women in midwifery care who had a home birth

20

Percent (%)

Proportion of women <20 years at delivery, by LHIN of birth

Ontario†, 2009–2010

Source – Ontario Midwifery Program Maternal‐Newborn Health Reporting System (Ontario MOHLTC), 2009–2010 † Ontario residents only

6.0 4.9 3.8 5.0 2.5 1.4 1.7 1.8 3.9 6.4 3.2 4.9 8.8 12.8 3.6 5 10 15 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women

21

Percent (%)

Proportion of women <20 years at delivery

Ontario†, 2009–2010

LHIN region of birth

5.3 4.5 2.2 4.0 8.4 3.6 2 4 6 8 10 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

22

Percent (%)

Proportion of women <20 years at delivery

Ontario†, 2005–2006 to 2009–2010

Fiscal year

3.4 3.6 3.7 3.8 3.6 1 2 3 4 5 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

23

Percent (%)

Proportion of women ≥35 years at delivery, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

15.6 14.6 17.9 17.8 18.5 24.6 32.9 26.5 18.1 13.2 22.9 15.9 10.5 11.4 21.4 5 10 15 20 25 30 35 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO Percent (%) of women

24

Percent (%)

Proportion of women ≥35 years at delivery

Ontario†, 2009–2010

LHIN region of birth

15.0 17.9 25.4 20.6 12.5 21.4

5 10 15 20 25 30 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

25

Percent (%)

Proportion of women ≥35 years at delivery

Ontario†, 2005–2006 to 2009–2010

Fiscal year

20.7 21.0 20.9 21.1 21.4 5 10 15 20 25 30 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

26

Proportion of women who were nulliparous at delivery, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

39.9 42.6 44.2 45.6 41.1 43.7 49.7 43.2 43.1 46.2 41.5 45.7 45.9 39.3 44.1 10 20 30 40 50 60 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women

27

Proportion of women who were nulliparous at delivery

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

41.6 45.0 44.8 42.6 44.4 44.1 10 20 30 40 50 60 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women

28

Proportion of women who were ≥35 years of age and nulliparous at delivery, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

22.5 23.9 26.1 27.6 19.6 25.9 37.3 26.0 22.6 26.7 25.5 27.4 27.1 22.3 27.7 10 20 30 40 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women

29

Proportion of women who were ≥35 years of age and nulliparous at delivery

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

23.4 27.1 28.9 25.7 26.3 27.7 10 20 30 40 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent of women with parity ≥2 (%)

Section II Pregnancy

30

31

Percent (%)

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates ** Estimate not shown because more than 30% of records had missing information

19.0 10.6* 9.0 8.1 30.1* 7.9 ** 14.4* ** 6.7 10.1 9.4 15.9 14.6 14.1* 5 10 15 20 25 30 35 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka… North East (13) North West (14) ONTARIO

Percent (%) of women

Proportion of women who did not attend an antenatal visit with a health care provider during the first trimester, by LHIN

• f birth

Ontario†, 2009–2010

32

Percent (%)

Proportion of women who did not attend an antenatal visit with a health care provider during the first trimester

Ontario†, 2009–2010

LHIN region of birth

14.2* 8.5 17.7* 9.2* 13.4 14.1* 5 10 15 20 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates

33

Proportion of women with pre-existing health conditions

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

37.9 27.7 24.8 30.7 32.7 28.1 10 20 30 40 50 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women

34

Proportion of women with pre-existing health conditions

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates

24.5* 27.3 28.3 29.3 33.4

10 20 30 40

2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Percent (%) of women

35

Percent (%)

Proportion of women with obstetrical complications

Ontario†, 2009–2010

LHIN region of birth

39.9 25.0 24.3 35.2 28.5 27.9 10 20 30 40 50 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

36

Percent (%)

Proportion of women with obstetrical complications

Ontario†, 2009–2010

Fiscal year

9.6* 14.2* 17.1* 26.2 27.9 10 20 30 40 50 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates

37

Rate of assisted conception, by LHIN of birth

Ontario†, 2009–2010

2.4 2.7 2.4 2.9* 2.7 2.6 3.6* 2.4 ** 1.5 ** 1.5 0.9* 0.7 2.3* 1 2 3 4 5 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates ** Estimate not shown because more than 30% of records had missing information

38

Rate of assisted conception

Ontario†, 2009–2010

LHIN region of birth

2.6 2.7 2.6* ** 1.1 2.3* 1 2 3 4 5 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates ** Estimate not shown because more than 30% of records had missing information

Section III Maternity health services

39

40

Levels of care

• Levels of care in Ontario hospitals are designated by the

Ontario Ministry of Health and Long‐Term Care

• These designations reflect the scope of medical services

available at a particular hospital and define the maximum level

• f the acuity and complexity of mothers and infants who can

be cared for at that hospital

• All hospitals care for mothers and infants who are healthy (low

risk) as well as those who are at the maximum level of acuity and complexity according to their hospital’s level of care designation

41

Levels of care

• At the time these reports were prepared, five levels of care

designation for maternal‐newborn services existed within Ontario:

Level of care Description

I Provide care for healthy mothers and infants >36 weeks’ gestation II/II+ Provide care for mothers and infants ≥32 weeks’ gestation Modified III (M3) Provide care for mothers and infants ≥29 weeks’ gestation without additional high risk maternal or fetal conditions III Provide care for all high‐risk pregnancies, including prematurity <32 weeks

• In May 2011, recommendations regarding new maternal and

newborn levels of care designation were announced by the Provincial Council for Maternal Child Health (PCMCH). These will likely phase in over the next several years and future BORN reports will reflect these new designations.

42

Distribution of live births at each level of care, by LHIN region

• f birth

Ontario†, 2009–2010

• Across Ontario, the

majority of live births took place in a Level II hospital (42.1%), followed by 22.4% in a Level II+ hospital, 15.5% in a Level III hospital, 13.3% in a Level I hospital and 6.7% in a modified Level III hospital.

• Geographic differences

in the distribution of live births at each level of care reflect the type of hospitals available in each LHIN as well as health service issues and practice patterns.

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

20 40 60 80 100 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of live births

Level I Level II Level II+ Level III Level M3

43

Distribution of live births at each level of care, by gestational age at birth

Ontario†, 2009–2010

• Across Ontario, the

proportion of live births that took place in a Level III hospital was highest in infants born between 24‐ 31 weeks (77.0% for 24‐27 weeks, 62.4% for 28‐31 weeks), which is the

• ptimal level of care for

this gestational age.

• Approximately a quarter

(26.7%) of infants born during a gestational period where survival is extremely low (<24 weeks’ gestation) were born at a Level III centre.

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

20 40 60 80 100 <24 weeks 24-27 weeks 28-31 weeks 32-33 weeks 34-36 weeks ≥37 weeks

Percent (%) of live births

Level I Level II Level II+ Level III Level M3

Section IV Birth

44

45

Percent (%)

Distribution of care provider who attended the hospital birth, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

• Across Ontario, the

majority of women had an

• bstetrician attend their

hospital delivery (85.4%).

• The proportion of

women whose care provider was a family physician at the time of their hospital delivery was 8.7% overall, but much higher in LHIN 14 (40.0%).

• Midwives were the

primary care provider for 4.3% of hospital births in

• Ontario. 12.2% of women

in LHIN 14 were attended by a midwife for their hospital delivery.

20 40 60 80 100 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ON

Percent (%) of women

Obstetrician Family physician Midwife Other

46

Distribution of care provider who attended the hospital birth, by LHIN region of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

• Across Ontario, the

majority of women had an

• bstetrician attend their

hospital delivery (85.4%).

• The proportion of

women whose care provider was a family physician at the time of their hospital delivery was 8.7% overall, and ranged from 6.2% in the GTA to 21.2% in LHINs 12–14.

• Midwives were the

primary care provider for 4.3% of hospital births in Ontario, and ranged from 3.0% in the GTA to 7.2% in LHINs 3&4 and LHINs 12– 14.

20 40 60 80 100 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women

Obstetrician Family physician Midwife Other

47

Fetal surveillance methods during labour, by LHIN of birth

Ontario†, 2009–2010

• Across Ontario, the

majority of women (62.6%) received electronic fetal monitoring (EFM) alone during labour. A further 26.8% of women were monitored with auscultation in combination with EFM.

• The proportion of

women who received auscultation alone was 9.1% overall, and ranged from 4.0% in LHIN 5, to 26.1% in LHIN 2.

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

20 40 60 80 100 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ON

Percent (%) of women who had spontaneous or induced labour

Electronic fetal monitoring only Auscultation & EFM Auscultation only No monitoring

48

Fetal surveillance methods during labour, by LHIN region of birth

Ontario†, 2009–2010

• Across Ontario, the

majority of women (62.6%) received electronic fetal monitoring (EFM) alone during labour. A further 26.8% of women were monitored with auscultation in combination with EFM.

• The regional proportion
• f women who received

auscultation alone was 9.1% overall, and ranged from 6.5% in the GTA , to 19.3% in LHINs 1&2.

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

20 40 60 80 100 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) women who had spontaneous or induced labour

Electronic Fetal Monitoring only Auscultation & EFM Auscultation only No monitoring

49

Rate of auscultation only for fetal surveillance during labour, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

7.9 26.1 11.9 7.2 4.0 9.2 8.0 4.4 6.2 5.9 11.0 7.2 10.4 14.0 9.1 5 10 15 20 25 30 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women who had spontaneous or induced labour

50

Rate of auscultation only for fetal surveillance during labour

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

19.3 9.0 6.5 9.7 10.2 9.1 5 10 15 20 25 30 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women who had spontaneous or induced labour

51

Rate of auscultation only for fetal surveillance during labour

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

9.3 9.3 9.1 9.1 9.1 2 4 6 8 10 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women who had spontaneous or induced labour

52

Percent (%)

Rate of auscultation only for fetal surveillance during labour among low-risk women, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

15.2 60.8 24.2 13.6 6.9 15.8 16.4 7.5 9.8 10.6 22.4 14.9 16.8 27.5 15.2 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women who had spontaneous or induced labour

53

Rate of auscultation only for fetal surveillance during labour among low-risk women

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

36.6 17.9 10.8 18.4 18.3 15.2 10 20 30 40 50 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women who had spontaneous or induced labour

54

Rate of auscultation only for fetal surveillance during labour among low-risk women

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

15.4 15.1 14.9 14.8 15.2 5 10 15 20 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women who had spontaneous or induced labour

55

Rate of labour induction, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

33.2 32.8 24.5 25.7 22.5 23.8 24.3 23.1 20.6 27.2 24.3 25.4 29.7 28.1 25.2 5 10 15 20 25 30 35 40 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women

56

Rate of labour induction

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

33.0 25.2 23.0 25.0 27.9 25.2 10 20 30 40 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women

57

Rate of labour induction

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

24.8 24.9 24.9 24.8 25.2 5 10 15 20 25 30 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women

58

Rate of labour induction among standardized nulliparous women

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

41.1 33.2 30.6 33.0 33.6 32.7 10 20 30 40 50 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women

59

Rate of labour induction among standardized nulliparous women

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

31.4 31.3 31.6 32.1 32.7 10 20 30 40 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women

60

Proportion of women who were <41 weeks of gestational age at delivery among women who were induced with a post-dates indication for induction of labour, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

18.7 12.1 18.0 18.5 27.5 8.2 9.5 26.4 25.0 9.6 15.9 17.8 30.8 14.2 18.0 5 10 15 20 25 30 35 40 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women who had labour induction for post dates indication

61

Proportion of women who were <41 weeks of gestational age at delivery among women who were induced with a post-dates indication for induction of labour

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

14.9 18.3 18.4 13.9 22.9 18.0 10 20 30 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women who had labour induction for post dates indication

62

Rate of assisted vaginal delivery, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

11.5 10.2 11.3 11.0 11.0 15.6 16.4 15.9 14.3 13.8 14.6 13.4 11.0 8.4 13.6 5 10 15 20 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women who had a vaginal delivery

63

Rate of assisted vaginal delivery

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

10.7 11.1 15.2 14.4 11.1 13.6 5 10 15 20 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women who had a vaginal delivery

64

Rate of assisted vaginal delivery

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

15.1 14.6 14.1 14.0 13.6 5 10 15 20 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women who had a vaginal delivery

65

Rate of assisted vaginal delivery among standardized nulliparous women, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

21.0 19.8 20.6 19.1 19.8 25.9 25.0 25.7 24.5 24.7 24.7 22.5 19.1 17.4 23.0 10 20 30 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central West (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women who had a vaginal delivery

66

Rate of assisted vaginal delivery among standardized nulliparous women

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

20.2 19.6 24.7 24.7 19.8 23.0 5 10 15 20 25 30 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women who had a vaginal delivery

67

Rate of assisted vaginal delivery among standardized nulliparous women

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

25.3 24.5 24.0 23.5 23.0 5 10 15 20 25 30 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women who had a vaginal delivery

68

Rate of cesarean delivery, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

25.4 22.7 25.1 28.8 30.8 25.8 32.3 28.7 28.7 28.1 29.2 32.1 28.4 24.7 28.3 10 20 30 40 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women

69

Rate of cesarean delivery

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

23.7 27.5 29.4 28.9 28.8 28.3 10 20 30 40 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women

70

Rate of cesarean delivery

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

27.7 27.7 27.8 28.6 28.3 10 20 30 40 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women

71

Proportion of women with a cesarean delivery performed prior to 39 weeks' gestation among low-risk women having an elective repeat cesarean delivery at term, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

42.0 44.3 42.8 50.9 64.4 55.5 66.2 66.9 60.6 57.0 50.1 45.5 58.8 55.8 57.6 10 20 30 40 50 60 70 80 90 100 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of low-risk women between 37-42 weeks having a repeat cesarean delivery

72

Proportion of women with a cesarean delivery performed prior to 39 weeks' gestation among low-risk women having an elective repeat cesarean delivery at term

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

42.9 47.9 63.1 52.6 53.1 57.6 20 40 60 80 100 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of low-risk women between 37-42 weeks having a repeat cesarean delivery

73

Rate of episiotomy, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

22.0 10.7 18.9 17.5 14.0 14.2 19.8 29.4 25.2 9.4 11.2 20.6 14.7 6.0 18.3 10 20 30 40 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women who had a vaginal birth

74

Rate of episiotomy

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

14.9 18.0 21.8 10.8 14.6 18.3 10 20 30 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women who had a vaginal birth

75

Rate of episiotomy

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates

19.7 20.2* 19.5* 18.8 18.3 10 20 30 40 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women who had a vaginal birth

76

Proportion of women with intrapartum complications

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

45.4 30.5 32.5 37.9 28.4 33.9 10 20 30 40 50 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women

77

Rate of pharmacologic pain management among women who had a vaginal live birth, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

• Across Ontario, 62.5%
• f women who had a

vaginal live birth used some form of regional

• anesthesia. 19.8% of

women used another form of analgesia.

• 76.2% of women in

LHIN 7 used some form of regional anesthesia; however, only 2.1% of these women used another form of

• analgesia. The reverse is

true for women who delivered in LHIN 14 (8.7% used regional and 72.6% used another form

• f analgesia).

54.8 54.2 57.7 64.2 61.5 68.8 76.2 70.0 61.5 55.1 62.2 55.9 43.6 8.7 62.5 39.8 22.6 22.2 19.8 13.4 7.7 2.1 10.0 19.8 50.7 30.7 33.8 35.2 72.6 19.8 20 40 60 80 100 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of women who had a vaginal live birth

Regional anesthesia Other analgesia

78

Rate of pharmacologic pain management among women who had a vaginal live birth

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

• Across Ontario, 62.5% of

women who had a vaginal live birth used some form

• f regional anesthesia.

19.8% of women used another form of analgesia.

• Across the GTA 68.8% of

women used a regional anesthesia; however, only 9.8% used another form of analgesia.

• In the North LHINs, only

39.4% of women used a regional anesthesia; however, 43.5% used another form of analgesia.

54.4 61.7 68.8 60.4 39.4 62.5 29.0 20.7 9.8 35.7 43.5 19.8 20 40 60 80 100 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent (%) of women who had a vaginal live birth

Regional anesthesia Other analgesia

79

Rate of pharmacologic pain management among women who had a vaginal live birth

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

59.3 61.8 61.6 61.8 62.5 21.9 21.3 21.7 21.6 19.8 20 40 60 80 100 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010

Percent (%) of women who had a vaginal live birth

Regional anesthesia Other analgesia

80

Fetal mortality rate ≥500 grams, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only Error bars represent upper/lower 95% bounds

• Across Ontario, the rate
• f stillbirth ≥500 g was

3.83 per 1,000 total births.

• Variability in rates may

be due to: (i) the number

• f Level III hospitals in a

LHIN (there may be more stillbirths in these hospitals as they provide care to more women with high‐risk pregnancies); (ii) small numbers (stillbirth is a rare event); and (iii) differences between hospitals in the complete capture of stillbirth records in the database.

3.73 3.77 2.49 3.66 2.12 3.83 6.02 2.77 3.38 4.83 3.58 4.40 3.18 7.95 3.83

5 10 15 20 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Rate per 1,000 total births ≥500 grams

81

Fetal mortality rate ≥500 grams

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only Error bars represent upper/lower 95% bounds

• Overall, the rate of

stillbirth ≥500 g was 3.83 per 1,000 total births.

• Variability in rates may

be due to: (i) the number

• f Level III hospitals in a

LHIN (there may be more stillbirths in these hospitals as they provide care to more women with high‐risk pregnancies); (ii) small numbers (stillbirth is a rare event); and (iii) differences between hospitals in the complete capture of stillbirth records in the database.

3.75 3.22 3.88 3.88 4.65 3.83 2 4 6 8 10 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO Rate per 1,000 total births ≥500 grams

82

Rate of preterm birth (<37 weeks), by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

7.4 8.8 6.0 8.5 7.9 6.4 11.4 6.7 6.9 9.2 9.5 7.3 7.6 6.3 8.2 5 10 15 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO Percent (%) of live births

83

Rate of preterm birth (<37 weeks)

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

LHIN region of birth

8.3 7.6 8.0 9.5 7.3 8.2 2 4 6 8 10 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO Percent (%) of live births

84

Rate of preterm birth (<37 weeks)

Ontario†, 2005–2006 to 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

Fiscal year

8.2 8.3 8.2 8.2 8.2 2 4 6 8 10 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Percent (%) of live births

85

Rate of small for gestational age, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

8.2 8.0 7.4 7.1 12.2 10.6 9.9 10.2 10.4 7.2 7.4 7.7 7.4 5.9 9.0 5 10 15 20 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO Percent (%) of singleton live births

86

Rate of small for gestational age

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

LHIN region of birth

8.1 7.2 10.5 7.3 7.2 9.0 5 10 15 20 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO Percent (%) of singleton live births

87

Rate of large for gestational age, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

10.8 12.8 11.2 12.3 7.4 8.9 8.7 8.4 9.8 12.2 12.1 11.2 13.3 17.0 10.4 5 10 15 20 25 30 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO Percent (%) of singleton live births

88

Rate of large for gestational age

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

LHIN region of birth

12.0 11.9 8.7 12.1 13.4 10.4 5 10 15 20 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO Percent (%) of singleton live births

89

Rate of multiple birth, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

3.0 3.5 3.1 3.7 3.3 3.0 5.7 3.1 2.7 3.8 4.1 3.4 2.9 2.8 3.6 2 4 6 8 10 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO Percent (%) of total births

90

Rate of multiple birth

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

3.3 3.4 3.7 4.0 3.0 3.6 1 2 3 4 5 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO Percent (%) of live births

91

Rate of multiple birth

Ontario†, 2005–2006 to 2009–2010

Fiscal year

Source – BORN Ontario (Niday Perinatal Database), 2005–2006 to 2009–2010 † Ontario residents only

3.5 3.4 3.5 3.4 3.6 1 2 3 4 5 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 Percent (%) of live births

Section V Postpartum and newborn

92

93

Proportion of live births with a 5-minute Apgar score <7, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

1.1 2.2 1.3 1.3 1.1 0.8 1.3 1.0 1.2 2.5 2.0 1.5 1.6 2.1 1.4 1 2 3 4 5 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO Percent (%) of live births

94

Proportion of live births with a 5-minute Apgar score <7

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

1.8 1.4 1.1 2.1 1.7 1.4 1 2 3 4 5 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO

Percent(%) of live births

95

Rate of exclusive breastfeeding at discharge among term live births, by LHIN of birth

Ontario†, 2009–2010

45.3 59.4 70.9 58.0* 37.8 63.1 69.3 § 59.6 54.3 § 56.4 64.9 72.8 61.3 57.6 59.8 § 20 40 60 80 100 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO

Percent (%) of term live births Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates § Individual hospital sites that do not collect information on breastfeeding at discharge from hospital, or that have >30% of records with missing information on this variable have been excluded from the denominator used for these calculations.

96

Rate of exclusive breastfeeding at discharge among term live births

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates § Individual hospital sites that do not collect information on breastfeeding at discharge from hospital, or that have >30% of records with missing information on this variable have been excluded from the denominator used for these calculations.

54.0 63.3* 58.9 § 62.4 64.4 59.8 § 20 40 60 80 100 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO Percent (%) of term live births

Section VI Maternal and newborn screening

97

98

Ratio of maternal multiple marker screening, by LHIN of residence

Ontario†, 2009–2010

Source – BORN Ontario (Ontario Maternal Multiple Marker Screening Program Database and Niday Perinatal Database), 2009–2010 † Ontario residents only

34.1 46.3 48.2 45.2 64.2 63.5 85.7 77.1 67.6 54.1 65.3 45.6 30.6 26.6 66.9 20 40 60 80 100 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO Screening ratio (%)

99

Ratio of maternal multiple marker screening

Ontario†, 2009–2010

LHIN region of residence

Source – BORN Ontario (Ontario Maternal Multiple Marker Screening Program Database and Niday Perinatal Database), 2009–2010 † Ontario residents only

41.5 46.4 72.2 62.4 34.9 66.9 20 40 60 80 100 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO Screening ratio (%)

100

Proportion of women who were screened for Group B Streptococcus among women who delivered at ≥37 weeks, by LHIN of birth

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates

97.0 92.1 90.3 88.6* 99.2* 91.8 94.1 95.3 95.6 91.0 94.8* 88.4 89.9 88.1 93.3 20 40 60 80 100 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO Percent (%) of women

101

Proportion of women who were screened for Group B Streptococcus among women who delivered at ≥37 weeks

Ontario†, 2009–2010

LHIN region of birth

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only * Between 10% and 30% of records and missing information and were excluded from the calculation of these estimates

94.0 89.3* 94.7 93.8* 89.0 93.3 20 40 60 80 100 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO Percent (%) of women

102

Number of infants with newborn screening completed and proportion who screen positive, by LHIN of residence

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

LHI N of residence Number of infants with newborn screening completed Number with a positive screen Proportion of infants with a positive screen Erie St. Clair (1) 6,208 79 1.27 South West (2) 9,863 85 0.86 Waterloo Wellington (3) 8,333 77 0.92 HNHB (4) 13,353 124 0.93 Central West (5) 10,900 94 0.86 Mississauga Halton (6) 12,036 94 0.78 Toronto Central (7) 12,695 115 0.91 Central (8) 18,331 166 0.91 Central East (9) 15,722 144 0.92 South East (10) 4,425 34 0.77 Champlain (11) 12,869 130 1.01 North Simcoe Muskoka (12) 4,242 37 0.87 North East (13) 5,374 46 0.86 North West (14) 2,383 15 0.63 ONTARIO 142,990 1,312 0.92

103

Number of infants with newborn screening completed and proportion who screen positive, by LHIN region of residence

Ontario†, 2009–2010

Source – BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

LHI N region of residence Number of infants with newborn screening completed Number with a positive screen Proportion of infants with a positive screen 1&2 16,071 164 1.02 3&4 21,686 201 0.93 5–9 69,684 613 0.88 10&11 17,294 164 0.95 12–14 11,999 98 0.82 ONTARIO 142,990 1,312 0.92

104

Ratio of Parkyn screen completion, by LHIN of residence

Ontario†, 2009–2010

Source – Integrated Services for Children Information System (ISCIS), Ontario Ministry of Children and Youth Services and BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

92.4 83.6 88.1 92.3 81.5 84.0 80.3 83.2 85.1 84.8 91.9 83.1 88.2 70.2 85.5 20 40 60 80 100 Erie St. Clair (1) South West (2) Waterloo Wellington (3) HNHB (4) Central West (5) Mississauga Halton (6) Toronto Central (7) Central (8) Central East (9) South East (10) Champlain (11) North Simcoe Muskoka (12) North East (13) North West (14) ONTARIO Screening ratio (%)

105

Ratio of Parkyn screen completion

Ontario†, 2009–2010

LHIN region of residence

Source – Integrated Services for Children Information System (ISCIS), Ontario Ministry of Children and Youth Services and BORN Ontario (Niday Perinatal Database), 2009–2010 † Ontario residents only

87.1 90.7 83.0 90.1 82.6 85.5 20 40 60 80 100 ESC-SW (1&2) WW-HNHB (3&4) GTA (5−9) SEC (10&11) North (12−14) ONTARIO Screening ratio (%)