Trends in small hospital obstetric services in Ontario

To compare obstetric services provided in small Ontario hospitals in 1995 with those provided in 1988. Mailed survey questionnaire. Small hospitals in Ontario. Chiefs of Staff of the hospitals. Hospital size and location; numbers of physicians; availability of obstetric, anesthesia, and general surgery services; and other medical services. The 1995 questionnaire was identical to the 1988 one, except for addition of questions on midwives and deletion of the detailed emergency medicine section. A study group of 35 hospitals that provided active obstetric care in both years had significantly fewer births, fewer family physicians attending births, and fewer GP anesthetists in 1995 than in 1988. There were fewer cesarean births, but a similar number of epidural anesthetics. Availability of anesthetic, epidural, and cesarean services was significantly lower in 1995 than in 1988 in these 35 hospitals. Also, 11 other hospitals that had provided active obstetric care (defined as more than 25 births yearly) in 1988 no longer did so in 1995. By almost all measures, obstetric services in these rural Ontario hospitals were less available in 1995 than they had been in 1988.