Canada’s C-section rate at record high

Canada’s C-section rate at record high

Canada’s pregnancy specialists are calling on doctors to curb the fast-growing use of caesarean sections to deliver babies, saying the worrisome trend is exposing mothers and infants to more risk, not less.

With one in four births now occurring by C-section – 92,799 babies a year – it is time to get “back to the basics,” says Dr. Vyta Senikas, associate executive vice-president of the Society of Obstetricians and Gynaecologists of Canada.

The group is urging doctors and women to choose a C-section only when there is a medical reason to justify one. “Safety of a woman and a baby should be the driving decisions here,” Senikas said.

“We have to come back to the basics, and the basics are that 90 per cent of women will have a nice vaginal delivery without any problems to produce a healthy mother and baby.”

According to the Canadian Institute for Health Information, the national C-section rate reached 26.3 per cent in 2005-06, up from 17.6 per cent in 1993. The World Health Organization says any rate higher than 15 per cent signals “inappropriate usage.”

In B.C, nearly one-third of babies (30.5 per cent) were delivered surgically in 2006-07, the third-highest province behind P.E.I. (31.4 per cent) and Newfoundland and Labrador (30.6 per cent). The C-section rate was 27 per cent in Alberta and 27.8 per cent in Ontario, while Saskatchewan (20.8 per cent) and Manitoba (19.8 per cent) had among the lowest rates. Quebec data were unavailable, but in 2005-06 the rate in Quebec was 22.9 per cent.

Doctors said several factors are driving the push for surgical births, from fear of pain during childbirth and the convenience factor to the growing proportion of expectant mothers who are obese.

Twenty-three per cent of women of childbearing age in Canada are obese, and the obesity rate has doubled among 25- to 34-year-old women – the group that gives birth to more than 60 per cent of babies born in Canada ever year – in the past 25 years.

A woman with a body mass index of 30 or more is considered obese. Obstetricians say it’s not uncommon to see a woman with a pre-pregnancy BMI of 50 or higher.

Obese women tend to have bigger and chunkier babies, as well as longer labours, which increases the risk of a C-section.

Once in surgery, obese women have a higher risk of bleeding, wound infections and damage to organs such as the intestines and bladder. Anesthesia on a heavy woman is also “fraught with risks,” because it’s harder to maintain an airway, Senikas said. There is also a risk of injury to the baby.

Demographics have also pushed Canada’s C-section rate to an all-time high. The average age of a Canadian woman who had a C-section in 2005-06 was 30.4, compared to 28.7 for women who had a vaginal delivery, according to the Canadian Institute for Health Information.

The older a woman, the more slowly labour tends to proceed, and if she required assisted reproductive technologies to get pregnant, “this may be the once-in-a-lifetime pregnancy,” Senikas said. “If things aren’t proceeding as quickly as they would like it to, they want a C-section more immediately.”

“If we’re dealing with an older woman, someone who may have had five years of infertility who finally got pregnant, many of these women are under the mistaken conception that a C-section is just going to be perfect and of course they’re willing to do anything to maintain 100 per cent health of the baby.”

But, “90 per cent of women are low-risk, and will have a safe vaginal delivery.”

The country’s soaring C-section rate is also being driven by C-sections on demand, a phenomenon labelled “too posh to push” after Victoria Beckham and other celebrity moms began popularizing the practice.

The Society of Obstetricians and Gynaecologists estimates only one to two per cent of C-sections in Canada are performed because the mother requested one. But elective C-sections carry higher risks of anesthetic complications, major infections and cardiac arrest. As well, women who have an elective C-section are more likely to need an emergency hysterectomy due to bleeding.

Connie Thompson, 38, had three C-sections before giving vaginal birth to her only daughter.

Her first birthing experience in 1991 was the most traumatic, she said. When her labour didn’t progress, the doctor broke her amniotic sac instead of sending her home, then told her the baby’s health was compromised, even though Thompson said her son’s heartbeat remained strong and regular.

“It was just a coerced caesarean because it was a Friday evening,” Thompson said. “Obviously he had plans that night.”

In a follow up medical appointment, the doctor told her, “Now you don’t have to worry about going through labour again. You can just schedule your caesareans,” Thompson said, describing the old belief that vaginal birth wasn’t safe after a caesarean. “Well, I didn’t want that because I wanted to experience normal birth.”

Thompson had two more sons by C-section. Then came baby Breanna after 24 hours of labour and a smooth, natural home birth.

“It was like I finally had given birth,” Thompson said. “It was healing because of the trauma I had experienced with my first, which I realized during my third one had me holding my baby in because I was so fearful of birth.”

Thompson, who now coaches women during pregnancy, praised the Society of Obstetricians and Gynecologists for recommending that vaginal births remain viable, safe options even after a C-section.

But Thompson said nurses and doctors in crowded, understaffed hospitals are under pressure to speed along births to make room for the next mothers in line.

“In rushing birth, you cause a lot of complications and that leads to caesarean sections,” said Thompson, a member of the International Cesarean Awareness Network. She said surgery has also become normal, with women seeking out face lifts or tummy tucks – and now, C-sections.

When Dr. Guylaine Lefebvre graduated from residency in 1999, “we just couldn’t offer an operation to someone who, in our eyes, didn’t need it.

“We believe there are a certain number of women who are afraid of childbirth. And there is some evidence that we’re moving to a societal change where we’ve lost confidence in the fact a woman will be able to deliver normally,” said Lefebvre, president of the obstetrician’s group and chief of the department of obstetrics and gynecology at Toronto’s St. Michael’s Hospital.

For some women, “there’s the element of timing. It’s more convenient to book a caesarean and chose a birth date.”

“I would like to believe that in Canada there are no doctors out there suggesting to women they should have an elective caesarean,” Lefebvre said. Although she said women should have a choice, “our position is that normal childbirth should be encouraged and should be accessible to women across the country.”

A shortage of doctors willing to deliver babies is adding to the problem. “It’s very difficult to stay in your community and wait for labour if your hospital is more than 200 miles away and you have four kids at home already,” Lefebvre said.

Fewer family doctors are delivering babies and younger obstetricians “are no longer willing to provide care 365 days a year, 24/7.” That makes it more appealing to schedule a C-section.

There are also medical-legal issues at play.

“You can appreciate if the patient reminds the physician unless things are perfect here that there’s going to be issues at the end of the day, that sometimes may modify the outlook,” Senikas said. “No one likes to be held hostage in these situations.”

The doctors’ group is working on a caesarean-information pamphlet for pregnant women.

“I think it’s important to reassure women that a caesarean is relatively safe but it does have higher risks of complications than normal childbirth,” Lefebvre said.

With files from the Edmonton Journal

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