{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T18:26:08Z","timestamp":1774895168938,"version":"3.50.1"},"reference-count":71,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The importance of understanding the continuum of care throughout the perinatal\/postpartum periods is important for health system monitoring and quality improvement. In this study, we take a broad-ranging and longitudinal perspective to examining long-term changes in obstetric care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective population-based study including all liveborn deliveries from 2010\u20132023 in Ontario, Canada. We used the hospital Discharge Abstract Database to link delivery and newborn abstracts. We report year-over-year changes in socio-demographics, clinical factors, care patterns, and perinatal and postpartum outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The number of in-hospital births decreased from 133,957 in 2010\u2013127,660 in 2023. Over the study period, delivery age increased from a mean 30.6 years (SD 5.5) in 2010 to 32.2 (SD 4.9) in 2023 and there was at least a doubling in the proportion of persons who delivered having preexisting\/gestational diabetes (5.6% in 2010, 11.1% in 2023), obesity (1.6% in 2010, 4.6% in 2023), pre-eclampsia\/eclampsia (1.1% in 2010, 2.6% in 2023), liver disorders (0.43% in 2010; 1.16% in 2023), and other diseases (4.9% in 2010, 10.7% in 2023), p\u2009&lt;\u20090.0001 for all. The proportion of deliveries performed via C-section increased over time (29.3% in 2010, 34.6% in 2023) but the median length-of-stay decreased 2.68% year-over-year. Use of epidural increased non-linearly over the study period and was less likely at lower-volume hospitals. Although uncommon (&lt;5%), the rate of obstetric trauma and birth trauma increased over the study period, regardless of the mode of delivery (p\u2009&lt;\u20090.0001). Six-month mortality did not change over the study period after delivery, while infant mortality decreased (0.35% in 2010 to 0.26% in 2023). We also observed substantial hospital-level variation in utility of services including midwifery care and access to epidural.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Over the last 14 years, we found an increasing incidence of people giving birth at an older age and having complicating clinical characteristics at the time of delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0342215","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T17:31:57Z","timestamp":1774891917000},"page":"e0342215","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal-spatial trends in childbirth in Ontario, 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