Small Hospital Obstetrics: Is Small Beautiful?*


  • Geordie Fallis,

    Corresponding author
    1. GEORDIE B. FALUS, M.D., CCFP, is an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto and staff physician at the Flemingdon Health Center in Don Mills, Ontario. After completing a Family Medicine residency program in Toronto, he worked for six years in rural areas of British Columbia, Newfoundland, Africa and New Zealand prior to accepting his faculty appointment. His studies include seasonal variations in birthweights in rural Zaire, rural obstetrics in Zaire and the use of the obstetrical vacuum extractor in a rural hospital in Canada.
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  • Earl Dunn,

    1. EARL V. DUNN, M.D., C.M., is Professor in the Department of Family and Community Medicine and the Centre for Studies in Medid Education at the University of Toronto. He graduated from McGill University (Montreal). He has been interested in research in rudtemote health care since 1974, including assessing the care provided by non-physician providers and the evaluation of communications technology in rural areas. His publications on rural health have appeared in 7he Journal of Ruml Haaltb, Health Seruis Reseutcb, the American Journal of Public H d t b, the Canadian Journal of Public Haalth, the Journal of Medical Education, Medical Education, and the Canadian Mediuil Association Journal. He is co-author of the text Emluuting Telecornrnunications Technology in Medicine, His present interests include the use of “decision analysis” techniques in the planning and assessment of ruraVremote health care.
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  • John Hilditch

    1. JOHN R HILDITCH, M.D., M.P.H., is an Associate Professor in the Department of Family and Community Medicine and the Department of Preventive Medicine and Biostatistics at the University of Toronto. He received his M.D. degree from the University of Toronto and his M.P.H. from the University of Washington. He has done research in the seasonality of illness, hypertension and health care delivery.
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  • *

    We would like to thank the Hospital Medical Records Institute for their help in retrieving the data and the Department of Family and Community Medicine, University of Toronto for their financial assistance Special thanks to Pat Tiffin for typing the manuscript

Reprint requests to: Dr. Geordie Fallis, Flemington Health Centre, 10 Gateway Boulevard, Toronto, Ontario, Canada, M3C 3A1.


The number of deliveries in small Canadian hospitals over the last 15 years was reviewed. The two provinces with the highest percentage of deliveries in small hospitals had similar patterns of Perinatal Mortality Rates to the two provinces with the lowest percentage of small hospital deliveries. Birthweight specific mortality rates for newborns weighing greater than 2,500 grams was lower in small hospitals compared to larger hospitals in the provinces of Ontario, Newfoundland and Saskatchewan for 1985. In Ontario, for the year 1985, even when corrected for perinatal transfers and the home address of the mother, there were no significant differences in perinatal mortality between those hospitals with less than 400 births, those between 401 and 2,999 births and those with 3,000 or more births. Within the present Canadian system of perinatal regionalization, small hospital obstetrics is safe.