Since BORN was formed in 2009, health care providers and decision makers now have improved tools to continue working together to collect and use data about the health of infants and mothers in Ontario. This data has led to important changes in health care practices, outcomes, and policy decisions. At the same time, the data is providing a snapshot into the overall health of Ontario and the areas where improvements are still needed.
Recently, the Better Outcomes Registry & Network (BORN Ontario) released a report containing health data and practice highlights ranging from prenatal screening rates to breastfeeding practices… and everything in between. The report shows improvements in exclusive breastfeeding rates and a reduction in women who smoked during pregnancy. Meanwhile, work is still needed to adjust the timing of repeat c-sections for low-risk women and inductions in overdue women.
Among the report’s highlights
Maternal age: 56.4 per cent of women who gave birth were 30 years of age or older. The largest proportion of births was to women between the ages of 30 and 34 (34.3%). During the same period, three per cent of births were to women 19 years of age and under, while 22 per cent were to women 35 years of age and over.
Prenatal screening: the proportion of pregnant women who had prenatal screening rose to 68.4 per cent up from 68.2 in 2010-2011 and 66.9 in 2009-2010.
First time mothers: 43.3 per cent of women who gave birth were first time mothers.
Smoking: the percentage of women who reported smoking during pregnancy at 20 weeks’ gestation or later declined, standing at nine per cent in 2011–2012 down from 9.7 in 2010–2011 and 10.2 in 2009–2010.
Regional anesthesia: 63.4 per cent of women used some form of regional anesthesia for pain management during labour.
Cesarean sections: C-section rates were stable over the five year period from 2007–2008 to 2011–2012 at approximately 28. per cent. Specifically related to elective repeat C-sections performed prior to 39 weeks’ gestation among low-risk women, BORN has developed an audit and feedback tool (the Maternal Newborn Dashboard) to help hospitals monitor their performance and reduce rates. The quarterly rates have been reduced from 54.6 per cent, prior to launch of the dashboard, to 44 for May 1 to July 31, 2013, but are still much higher than the target benchmark value of 11 per cent or less.
Induction rates: another indicator from the BORN Maternal Newborn Dashboard focuses on reducing inductions performed too early when the woman wasn’t actually past 41 weeks gestation. This proportion was reduced from 24.7 per cent prior to launch of the dashboard to 20.1, but is still higher than the benchmark.
Breastfeeding: exclusive breastfeeding is an important determinant of neonatal and infant health and is associated with reducing childhood obesity. The rate of exclusive breastfeeding at discharge among term live births in Ontario increased to 63.2 per cent in 2011-2012, up from 61.6 in 2009-2010 and 59.8 in 2007-2008.
How hospitals and health providers are using BORN Data
We know that our lifelong health trajectory is influenced by what happens in the first few days, weeks, and months of our lives. This period is often as important as what we do throughout our lifetime. It is for this reason that the data collected and made available through BORN Ontario is quickly finding its way to the centre of Ontario’s health care system. Our collective investments in quality data has a real impact and helps to ensure newborns have the best possible start and opportunity for a healthy future.
Over the last year, Ontario’s hospitals have been particularly successful at using the data to improve their practices and outcomes. For example, the Markham Stouffville Hospital has been working to reduce the number of c-sections among low-risk women, ensuring that the procedure occurs only when necessary. Using BORN data, the hospital was able to track their own information step-by-step to determine that high rates resulted from, in part, their induction practices. Armed with this information, the hospital revised its induction procedures and successfully reduced the number of c-sections performed in their hospital. In another hospital, BORN Ontario data was also key in a pilot program to improve care and reduce costs by keeping more mothers and newborns together after birth rather than separating the newborn in a neonatal intensive care unit. The data was also successfully used to monitor and reduce the number of unsatisfactory newborn screens for rare genetic diseases from 16 per cent to seven per cent in one hospital, thus reducing repeat tests and return visits.
The quality of the data depends on all of us working together. At BORN Ontario, we are privileged to have a variety of partners as we collect data from fertility clinics, midwifery practices, prenatal and newborn screening labs, follow up clinics, and hospitals. Collecting data from such a wide range of stakeholders allows for a more complete picture of maternal child health in Ontario. To learn more about how you can use BORN data, please contact us or visit our website (www.bornontario.ca).