The Canadian Obstetric Survey System (CanOSS) has launched its first provincial pilot in Ontario, working with the Better Outcomes Registry & Network (BORN) Ontario to better understand severe maternal complications and use what is learned to improve care.
The launch coincides with World Postpartum Hemorrhage Day, a global call to reduce maternal deaths caused by excessive bleeding following childbirth. CanOSS Ontario will begin with a focus on severe postpartum hemorrhage, the leading cause of maternal deaths following childbirth in Ontario. Future review cycles are expected to examine other serious maternal conditions, including sepsis and complications from preeclampsia.
CanOSS is designed to look beyond population-level data and examine the circumstances surrounding serious maternal complications in greater depth. Confidential, multidisciplinary reviews will identify patterns and modifiable factors that may point to changes in care, while protecting the privacy of patients, families and institutions.
Rohan D’Souza, who leads CanOSS Ontario, said the response from hospitals and assessors across the province has shown a strong willingness to learn from these cases.
“Severe maternal complications are rarely explained by one factor alone,” said D’Souza. “Understanding what sits behind them is essential if we want to improve care. The response from hospitals and assessors across Ontario has been overwhelming. There is a genuine willingness to look closely at these events, learn from them, and use that knowledge to make births safer.”
D’Souza is an Associate Professor in McMaster University’s Department of Obstetrics & Gynecology and Department of Health Research Methods, Evidence, and Impact, and Canada Research Chair in Maternal Health. Twenty-four birthing facilities are participating in the Ontario pilot, alongside members of the CanOSS Ontario College of Assessors.
The College brings together expertise from obstetrics, midwifery, nursing, family medicine, critical care, obstetric anaesthesia and internal medicine. Through the review process, assessors will consider not only what happened in individual cases, but the wider factors that may have contributed and what can be learned from them.
The work also builds on a longer effort to make better use of the information already collected across Ontario’s maternal health system.
“This is exactly why the networks were formed,” said Dr. Jon Barrett, Professor and Chair of the Department of Obstetrics & Gynecology at McMaster University.
“The goal was to move beyond simply building a repository of information and use that data to improve outcomes. If Ontario can do this, it can help show the way for the rest of Canada and demonstrate how data-driven action and networks working together can improve patient outcomes. Seeing that work move into practice makes the years of conversations and effort behind it worthwhile.”
BORN Ontario is providing the registry infrastructure that makes the provincial pilot possible, including data collection, governance, privacy protection and knowledge translation. CanOSS Ontario is leading the confidential enquiry process, synthesis of findings and dissemination of actionable strategies.
For Alicia St. Hill, Executive Director of BORN Ontario, learning from severe complications offers an opportunity to move beyond documenting what has happened and consider what could be prevented in the future.
“At BORN Ontario, we believe every pregnancy and birth has something to teach us,” said St. Hill. “While maternal deaths are rare, severe maternal complications resulting in severe morbidity, like hemorrhage, affect many more women and families across our province. By helping our system understand and learn from these experiences, we can move beyond counting adverse events to preventing them.”
