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Evidence to Improve Care

Caesarean Delivery Rate Review


Ontario Health Technology Advisory Committee Recommendations

After considering the evidence and the recommendations from the Expert Advisory Panel on Rate Variation in Caesarean Sections Across Ontario, the Ontario Health Technology Advisory Committee recommended that:

  • The Better Outcomes Registry & Network (BORN) Ontario, with the Provincial Council for Maternal Child Health, provide audit and feedback to individual hospitals regarding their low-risk obstetrical population to support quality improvement in maternal-infant care.

  • Health Quality Ontario, in collaboration with BORN, track induction rates (proportion of women who were induced with an indication of post-dates and were less than 41 weeks’ gestation at delivery) and Caesarean delivery rates (in low-risk nulliparous women) as key performance indicators.

Read the full OHTAC Recommendation



Caesarean delivery (also known as a C-section) is an operation to deliver a baby. It can be performed when a vaginal delivery would be risky for the mother or the baby. However, the mother and/or baby may have serious complications from a Caesarean delivery, and women who have had one surgical delivery have more risk of complications during future births.


Health Quality Ontario Reviews Caesarean Delivery Rates in Ontario

To understand if Caesarean deliveries are being done only when necessary, it is important to know how many are performed in Ontario and what factors are associated with higher or lower rates. For example, how many Caesarean deliveries are for nulliparous (first-time) mothers and how many are performed for women who do not have a high risk of complications?


Caesarean Delivery Rate Review: An Evidence-Based Analysis (PDF)
March 2015


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The Ministry of Health and Long-Term Care has accepted these recommendations.

The Ministry of Health and Long-Term Care has provided the following response: As recommended by Health Quality Ontario, the Better Outcomes Registry and Network (BORN) has an audit and feedback system for hospitals (the Maternal Newborn Dashboard) that tracks two indicators related to low-risk obstetrical population. BORN tracks the proportion of caesarean section births in low risk women done before 39 weeks gestation and the proportion of inductions of labour done before 41 weeks. BORN also provides data to Health Quality Ontario on a yearly basis.




Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee (OHTAC) — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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