The QUARISMA research project, undertaken jointly by the SOGC and Ste-Justine University Hospital Center, is designed to assess the impact of professional training on the reduction of C-section rates in 16 Quebec hospitals.

The Issue

Canada's C-section rate has risen steadily since the mid 1990s, causing concerns that this is also leading to increased risks during pregnancy.

  • In Canada, C-section rate increased from 21.2% in 2000 to 23.7% in 2003.
  • In Quebec, it increased from 18.5% in 2000 to over 22.6% in 2004.
  • The World Health Organization (WHO) recommends that no more than 15% of births should be performed by C-section.
  • In Quebec, a small feasibility study focusing on three hospitals in 2005-2006 found that 38% of the assessed C-section could have been avoided.
  • Several studies have highlighted an increase of maternal and prenatal morbidity associated with a C-section.

The main objectives of QUARISMA are:

  • An optimal management of the birthing mode;
  • The continuing improvement of the quality of obstetrical services;
  • A decrease of C-sections identified as avoidable according to the clinical practice guidelines in effect;
  • A decrease of the maternal and fetal morbidity among women who are at low risk of complications;
  • A decrease of lawsuits through the improved quality of obstetrical services.

Structure of the project:

Founded on the concepts of evidence-based practice, the QUARISMA project will offer SOGC-led training in optimal practices relating to the decision to offer a Cesarean section. Thirty-two Quebec hospitals will participate in the research project. Training will be offered at 16 of these hospitals, and the remaining hospitals will be studied as controls. Training programs are based on SOGC's peer-reviewed clinical guidelines. Training will commence in April 2009 and will be completed over the following year. Health indicators from all 32 hospitals are collected and ongoing analysis will assess the impact of this training on health outcomes. Results of the project will help to inform policy decisions about training protocols relating to cesarean section.