Amy J. Hobbs

Background: Understanding the costs to the healthcare system of caesarean delivery with a low‐risk indication (‘maternal request’) is important for informing policies on its use. Numerous studies have examined hospital length of stay (LOS)—a key driver of hospital costs—by actual mode of delivery (vaginal vs. caesarean). This comparison, however, is misaligned with the information available at the time of antenatal decision‐making, as a planned vaginal delivery could result in either an actual vaginal delivery or an emergency intrapartum caesarean. Objectives: To compare maternal LOS in hospital and hospital costs for pre‐labour caesarean delivery for a low‐risk indication with planned vaginal delivery. Methods: We conducted a population‐based cohort study of all singleton births ≥ 37 weeks from nulliparous pregnancies in British Columbia, Canada, 2013–2023, using the British Columbia Perinatal Data Registry. We identified pre‐labour caesarean deliveries for breech presentation (proxies for caesarean deliveries with no medical indication) as well as planned vaginal deliveries. We examined maternal total LOS in hospital, in days, and hospital costs. Differences were estimated using generalized linear models with a gamma distribution and a log link. Results: The planned caesarean group comprised 5545 women, and the planned vaginal group comprised 146,270 women (29% emergency caesarean). The total length of hospital stay for the planned caesarean group was 2.9 days and 2.7 days for planned vaginal delivery (absolute difference 0.22 days; relative difference 8.3%, 95% considence interval [CI] −1.75, 19.4). Hospital delivery admission costs were CDN$981 higher (95% CI 886, 1076) for low‐risk, pre‐labour caesarean delivery than planned vaginal delivery. Conclusion: Maternal hospital length of stay for pre‐labour caesareans for a low‐risk indication was similar to planned vaginal delivery, while hospital costs were 21% higher. These findings provide contemporary evidence to help inform policy development on the use of ‘maternal request’ caesareans, alongside other clinical, patient, and health system considerations.

Background: With the recent legalization of cannabis in Canada, there is an urgent need to understand the effect of cannabis use in pregnancy. Our population-based study investigated the effects of prenatal cannabis use on maternal and newborn outcomes, and modification by infant sex. Methods: The cohort included 1,280,447 singleton births from the British Columbia Perinatal Data Registry, the Better Outcomes Registry & Network Ontario, and the Perinatal Program Newfoundland Labrador from April 1st, 2012 to March 31st, 2019. Logistic regression determined the associations between prenatal cannabis use and low birth weight, small-for-gestational age, large-for-gestational age, spontaneous and medically indicated preterm birth, very preterm birth, stillbirth, major congenital anomalies, caesarean section, gestational diabetes and gestational hypertension. Models were adjusted for other substance use, socio-demographic and-economic characteristics, co-morbidities. Interaction terms were included to investigate modification by infant sex. Results: The prevalence of cannabis use in our cohort was approximately 2%. Prenatal cannabis use is associated with increased risks of spontaneous and medically indicated preterm birth (1.80[1.68–1.93] and 1.94[1.77–2.12], respectively), very preterm birth (1.73[1.48–2.02]), low birth weight (1.90[1.79–2.03]), small-for-gestational age (1.21[1.16–1.27]) and large-for-gestational age (1.06[1.01–1.12]), any major congenital anomaly (1.71[1.49–1.97]), caesarean section (1.13[1.09–1.17]), and gestational diabetes (1.32[1.23–1.42]). No association was found for stillbirth or gestational hypertension. Only small-for-gestational age (p = 0.03) and spontaneous preterm birth (p = 0.04) showed evidence of modification by infant sex. Conclusions: Prenatal cannabis use increases the likelihood of preterm birth, low birth weight, small-for-gestational age and major congenital anomalies with prenatally exposed female infants showing evidence of increased susceptibility. Additional measures are needed to inform the public and providers of the inherent risks of cannabis exposure in pregnancy.

In Tanzania, maternal and newborn deaths can be prevented via quality facility-based antenatal care (ANC), delivery, and postnatal care (PNC). Scalable, integrated, and comprehensive interventions ...

The “percentage of births attended by a skilled birth attendant" (SBA) is an indicator that has been adopted by several global monitoring frameworks, including the Sustainable Development Goal (SDG) agenda for regular monitoring as part of target 3.1 for reducing maternal mortality by 2030. However, accurate and consistent measurement is challenged by contextual differences between and within countries on the definition of SBA, including the education, training, competencies, and functions they are qualified to perform. This scoping review identifies and maps the health personnel considered SBA in low-to-middle-income-countries (LMIC). A search was conducted inclusive to the years 2000 to 2015 in PubMed/MEDLINE, EMBASE, CINAHL Complete, Cochrane Database of Systematic Reviews, POPLINE and the World Health Organization Global Index Medicus. Original primary source research conducted in LMIC that evaluated the skilled health personnel providing interventions during labour and childbirth were considered for inclusion. All studies reported disaggregated data of SBA cadres and were disaggregated by country. The search of electronic databases identified a total of 23,743 articles. Overall, 70 articles were included in the narrative synthesis. A total of 102 unique cadres names were identified from 36 LMIC countries. Of the cadres included, 16% represented doctors, 16% were nurses, and 15% were midwives. We found substantial heterogeneity between and within countries on the reported definition of SBA and the education, training, skills and competencies that they were able to perform. The uncertainty and diversity of reported qualifications and competency of SBA within and between countries requires attention in order to better ascertain strategic priorities for future health system planning, including training and education. These results can inform recommendations around improved coverage measurement and monitoring of SBA moving forward, allowing for more accurate, consistent, and timely data able to guide decisions and action around planning and implementation of maternal and newborn health programmes.