TORONTO — We all know where babies come from, but a new report provides a glimpse at what goes on in the delivery room as these bundles of joy make their debut.

Approximately 374,000 babies were born in Canadian hospitals in 2008-2009, an increase of 4.8 per cent from 2006-07, according to statistics released Tuesday by the Canadian Institute for Health Information.

Among provinces, rates for woman having a first baby by caesarean section were highest in Newfoundland and Labrador, at 23 per cent, and British Columbia, at 22 per cent, and lowest in Manitoba, at 13.5 per cent.

Jacinth Tracey, manager of decision support and analytical product at the institute, says C-sections have been steadily increasing, but patterns differ across jurisdictions depending on the preferences of patients and practitioners.

"They're only done when it's medically necessary, but the definition of medically necessary is still kind of nebulous in some people's minds," she said in an interview.

"And certainly people are saying well: Is it physicians' preferences in collaboration with patients' preferences? Is it just a shift in demographic, meaning that older women tend to have on average higher-risk pregnancies, or with in-vitro fertilization there is the risk of multiple babies, and sometimes those necessitate a C-section intervention?"

The Canadian average for women under 35 having a first baby via C-section has remained steady at about 17.5 per cent for the last three years, she said.

But for those 35 and over, there was a slight increase to 23.7 per cent in 2008-09, from 22.9 per cent the previous year.

The study found that use of an epidural varied significantly -- for example, the hip- and leg-numbing anesthetic was given before 69 per cent of vaginal deliveries in Quebec and before 60 per cent of births in Ontario.

But only 38.5 per cent of deliveries in Manitoba and 30 per cent in British Columbia were preceded by epidurals.

"It could depend on culture, it could depend on availability," said Dr. Andre Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada.

"For instance, epidural rates in Quebec -- it's kind of a standard to have anesthesia available 24 hours a day for obstetrical units so it's not surprising that people would use it more."

The age of first pregnancy in Canada is now over 30 years old, he noted, and use of epidurals is greater among older women.

He said CIHI should dig deeper into the statistics to find out whether availability accounts for the regional differences.

For instance, Lalonde said he was told that a major hospital in British Columbia was losing its anesthesiology services in the obstetrics department. If the hospital's anesthesiologists were all tied up doing general surgeries, then the obstetrics department would have to do without.

The report Tuesday also noted that vacuum extraction was used in 9.9 per cent of deliveries and forceps helped things along in 3.3 per cent of deliveries.

"Vacuum is really for when the baby is very close to being born but the woman has been in labour too long and is now weak and doesn't have the strength to push the baby out," Lalonde explained, adding that Canadian doctors are well trained in these techniques and often practise on mannequins.

Forceps are mostly used nowadays for changing a baby's position, he added.

There's been no real change for three years in the statistics on low birth weight babies, with about one in 16 infants hitting the scales at less than 5.5 pounds.