Safe Reduction of Cesarean Sections in Quebec : For Healthier Mothers and Infants

Thursday, 30 April 2015

Professional training and self‐assessment in obstetric clinical practice appear to be effective in reducing the rate of cesarean sections, thereby improving the health of mothers and their infants as well as bettering the services they receive.


This was demonstrated in the QUARISMA study (quality of care, management of obstetric risk, and mode of delivery in Quebec) headed up by Nils Chaillet, PhD, a researcher at the Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS) and professor in the Faculty of Medicine and Health Sciences (FMSS) at the Université de Sherbrooke. The researchers observed that the cesarean‐section rate decreased in the intervention group (from 22.5% to 21.8%), while it continued to increase in the control group (from 23.2% to 23.5%). At the same time, the researchers observed a reduction in serious complications in the newborns, suggesting that the reduction in the cesarean‐section rate is safe and that the program could improve the health of children. The findings of the study carried out in 32 Quebec hospitals between 2008 and 2012 were published in the prestigious The New England Journal of Medicine on April 30.


The rate of cesarean sections continues to climb in industrialized countries. From 2000 to 2012, the rate in Quebec rose from 18.5% to 23.6% (19,974 cesarean sections out of 84,393 deliveries). This increase is a cause of concern because of the potential complications for the mother and infant associated with cesarean sections that are not medically necessary and the impacts that the health costs of such procedures engender.



The QUARISMA study, coordinated by the Centre de recherche du CHU Sainte‐Justine, is consonant with the objectives targeted under the provincial Ministry of Health and Social Services' 2008–2018 perinatal policy. This policy aims at reducing recourse to not medically necessary obstetric interventions and underscores the importance of increasing our knowledge about the factors that could help ensure the pertinence of obstetric interventions as well as their impacts on the health of the mother and child.


QUARISMA researchers assessed the impact of a training program jointly developed with the Society of Obstetricians and Gynaecologists of Canada (SOGC) on the rate of cesarean sections in Quebec, obstetric interventions, and the health of mothers and their children. This program is based mainly on professional training and self‐assessment in clinical practice.


"The health‐care professionals participating in the program were asked to analyze and modify the care process in their hospitals," explained Nils Chaillet, a specialist in assessing care quality. "The results of these assessments have fostered team spirit in each hospital and resulted in the implementation of recommendations adapted to the needs of futures mothers and professionals, making it easier to select the right intervention for the patient at the right time. By improving our knowledge about prenatal‐care programs and effectiveness, we can help reduce the rate of cesarean sections and not‐medically‐necessary procedures, thereby improving the quality of care and the health of mothers and their children in Quebec and Canada."


QUARISMA is one of Quebec's first randomized perinatal studies aimed at linking clinical practice to local, provincial, and national infrastructure to generate and exchange knowledge. This novel model based on a collaborative approach has made it possible to respond to the specific needs of health‐care professionals by opening the way to dynamic exchanges with the participating centers, which speeds up the process for transferring and exchanging knowledge.


QUARISMA Spin‐offs

Since the results demonstrated that the QUARISMA program yielded a safe decrease in cesarean sections in Quebec, the researcher received additional funding in the amount of $200,000 from the Canadian Institutes of Health Research (CIHR) for 2014 to 2017. The objective of this second phase is to implement this training program in the 16 hospitals of the control group from the initial study and make it available as an optional additional module in MOREOB (AMPROOB), the Pan‐Canadian perinatal OB training program administered and implemented by the Salus Global Corporation. Salus Global’s MOREOB is a program developed through collaborative effort with the Society of Obstetricians and Gynaecologists of Canada and approved by the Ministry of Health and Social Services. This new initiative presents an interesting opportunity for SOGC and Salus Global to collaborate with QUARISMA to incorporate the new approach within MOREOB and thereby insure its Canadian distribution. The CIHR invested $5.5 million in the first phase of the QUARISMA study, which ran from 2008 to 2012. The study's lead investigators are Nils Chaillet, PhD, researcher with Centre de recherché du CHUS; Dr. Alexandre Dumont, MD, PhD, obstetrician‐gynecologist and research director of the University of Paris's Research and Development Institute; and Dr. William Fraser, obstetrician‐gynecologist and Director of the Centre de recherche du CHUS. Dr. Jean‐Charles Pasquier, CRCHUS researcher, also took part in this study.

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