TRENDS IN SMALL HOSPITAL OBSTETRIC SERVICES IN ONTARIO

OBJECTIVE To compare obstetric services provided in small Ontario hosp itals in 1995 with those provided in 1988. DESIGN Mailed survey questi onnaire. SETTING Small hospitals in Ontario. PARTICIPANTS Chiefs of St aff of the hospitals. MAIN OUTCOME MEASURES Hospital size and location ; numbers of physicians; availability of obstetric, anesthesia, and ge neral surgery services; and other medical services. The 1995 questionn aire was identical to the 1988 one, except for addition of questions o n midwives and deletion of the detailed emergency medicine section. RE SULTS A study group of 35 hospitals that provided active obstetric car e in both years had significantly fewer births, fewer family physician s attending births, and fewer GP anesthetists in 1995 than in 1988. Th ere were fewer cesarean births, but a similar number of epidural anest hetics. Availability of anesthetic, epidural, and cesarean services wa s 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. CONCL USION By almost all measures, obstetric services in these rural Ontari o hospitals were less available in 1995 than they had been in 1988.