Why do more babies die in Quebec?

Or how one terrible headline hides another, even worse one.

(Texte français disponible ici.)

The headline in Le Journal de Montréal is morbidly eye-catching: five babies died during childbirth.

(One might wonder why a story about Renaud Lavoie, a sports journalist, having had “the scare of his life” is considered more newsworthy than the indescribable tragedy of babies who actually died, but let’s move on.)

Inside, the newspaper devotes a full spread to the tragedy of parents who lost children after a full-term pregnancy.

A requested C-section that was performed too late. Another that went wrong. A delivery whose induction was postponed by a week due to the lack of availability at the maternity ward. Another C-section that was performed after 30 hours. And yet another that never took place.

Five babies who should have lived. Five lives that will never be. Five mothers and fathers who will be haunted by that moment for the rest of their lives.

And all of this happened at the same hospital, in Valleyfield.

My first thoughts are for the parents. The birth of my daughter, now fifteen today, could have turned into a nightmare had it not been for the surgeon, who appeared out of nowhere when no one else knew what to do, and saved the day.

Each of these individual tragedies is indescribable. But are they exceptional, or even abnormal? Even in the world’s best healthcare systems, there are accidents and mistakes, and there is no country where newborn mortality is zero. Sometimes, it happens. We just hope it doesn’t happen to us.

What do the numbers say? The article from Le Journal de Montréal provides some data. From 2014 to 2024, between 210 and 250 viable babies—meaning 28 weeks of gestation or more—did not survive in Quebec.

At first glance, the numbers appear stable from year to year, except for 2019.

From here on, we’re going to go beyond the journalist’s work and make the numbers speak (this isn’t a criticism, much less a judgment). And I apologize in advance for the grim math. The subject is as sensitive as it is essential, and there is more than meets the eye, as we’ll see.

First, a reminder. There are about 110 hospitals with a maternity ward in Quebec. That works out to about two stillborn babies per hospital every year. Not all hospitals have the same number of births, so the figure can vary from one to another. Also, some hospitals are specialized in children’s care, like Sainte-Justine or the Montréal Children’s. Still, as incredibly sad as five stillborn babies over five or six years are, it does not seem to be that uncommon. In fact, it is likely that there are likely hospitals where such events occur more frequently.

That leads to two questions.

The first: Are 200 or 250 baby deaths too many? And is Quebec doing worse than other places?

The second: Are things moving in the right direction? Just looking at the table in the Journal, I’m already pretty certain they are not, because the total number of births in Quebec has been declining for several years. So if the number of deaths is stable…

In 2014, the first year of the data set in the Journal, there were 88,036 births in Quebec, according to Statistics Canada. In 2024, there were 77,052. So, ten years later, with fewer births, we end up with more deaths at 28 weeks or later. Something is wrong.

I expanded the series to the early 1990s and linked it to the annual number of live births. The result is the number of late fetal deaths per 1,000 births, or the stillbirth rate.

Plotted on a line graph, it looks like this:

In the early 1990s, the ratio of stillbirths to live births was around 3 per 1,000. Over the next two decades, it gradually declined, stabilizing at around 2.4. In 2019, it reached a low of 2.1, but this seems to be an anomaly.

And, surprise, surprise—over the past five years, it has begun rising again, quite steeply. A rise from 2.4 to 3.3 amounts to an increase of nearly 40% in newborn mortality. That’s 70 more babies dying in a single year.

It’s even more painful when you look at what happened in Ontario during the same period. Please see the orange curve on the chart below.

For about 30 years, Ontario had a higher stillbirth rate than Quebec. The trend then reversed. If Quebec had the same rate as Ontario in 2024, about 40 babies would still be alive today.

Even though Ontario is doing better than Quebec, our neighbouring province is not a model. In Northern European countries, the neonatal mortality rate hovers around 2 per 1,000 births. In Korea and Japan, it is even lower.

The conclusion is brutal: if Quebec performed as well as Northern European countries, every year, about a hundred more babies would have their whole lives ahead of them. Over ten years, that’s a thousand children. Enough to fill a few primary schools…

+++++++

What happened?

I haven’t seen anything that would indicate a change in methodology explaining the reversal of the trend. Quebec made a slight adjustment to its criteria in 2019, but that only affects mortality rates between 20 and 23 weeks of pregnancy, not at 28 weeks and beyond. And Statistics Canada and the provinces have ensured for decades that the data are comparable from one province to another.

There remains another explanation, unfortunately plausible, logical, and consistent with the many red flags our healthcare system has been sending us for years: vulnerable patients waiting for years for a family doctor; tests that take too long to be performed; pathology results that get lost in the system; cancers detected too late and that have become more severe, even incurable; dozens of patients dying while waiting for heart surgery; others dying after being completely forgotten in the ER; prenatal checkups skipped for two trimesters. And so on.

Quebec’s healthcare system, constantly stretched to its limits, has been failing Quebecers for some time. Now it’s the newborns’ turn to pay a gruesome price.

+++++++

When my daughter was born, delivery was supposed to be routine. The doctor who had been monitoring the pregnancy suggested letting the resident doctor handle it, as it was a textbook case.

Then, labour began. The baby wouldn’t come out. One hour. Two hours. My then-partner-now-wife pushed as hard as she could, but to no avail. Her face was covered in red spots because she had strained so hard and tiny blood vessels had burst. Labour dragged on, and nurses, orderlies, and others started filling the room. At some point, there were a dozen of us. Everyone was offering their opinion, trying to get the baby out any way they could. Pull, push, try again. Nothing worked. I had the agonizing feeling that we were living an episode of ER. But George Clooney was nowhere to be found.

The resident doctor did not know what to do anymore. My wife was exhausted. A nurse said that the baby’s heart rate was slowing down.

I turned to the resident: “I think you need help.” It seemed to snap her out of it; she rushed out immediately. A few minutes later, our family doctor was there. Eventually, she decided to call in the surgeon.

A man in his early sixties arrived. He took a look, asked for the vacuum extractor, inserted it where the baby needed to come out, gave it a twist, and pulled my daughter out in no time. Annabelle was born. With a temporary cone head, but she was breathing. And the surgeon was gone, as fast as he came in.

The whole thing took two or three minutes.

I turned to a nurse and asked her, “Who’s that superman?” She told me he was a top surgeon, fed up with the dysfunctionality of a broken health-care system, and that, at the end of the year, he intended to retire to play golf and be done with the nonsense.

That was fifteen years ago.

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My name is Patrick Déry. I write (mostly in French) for a living, and do my best to Quebecsplain in English in this space.

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Methodological note: Regarding the number of live births in Quebec, the Institut de la statistique du Québec and Statistics Canada report very similar figures; however, I have used Statistics Canada’s figures for the purpose of comparison with Ontario.