C-Sections in Canadian Healthcare

Myth about C-Sections

• Common misconception: C-sections are on the rise because more mothers are requesting them.
• Reality: The increase in C-section rates is not primarily due to maternal request, but rather to medical decisions made by healthcare providers.

Statistics on C-Sections in Canada

• Increase in rates: Over one in four hospital births in Canada were by C-section in 2008-09, a nearly 10% increase from 1995-96.
• Health risks: C-sections carry higher risks than vaginal deliveries, including:
  • Cardiac arrest
  • Hysterectomy
  • Infection
  • Fever
  • Pneumonia
  • Blood-vessel clotting
  • Hemorrhaging
• Costs: A first-time C-section costs approximately \$2,265 more than a vaginal delivery. Reducing C-sections to the recommended 15% would save approximately \$25 million in Canada.

Maternal Choices Regarding C-Sections

• Limited maternal requests: Only 2-8% of C-sections are performed at the specific request of the mother (varies by province).
• Global preference: A systematic review indicates only about 16% of women worldwide prefer C-sections, dropping to 10% among those who have not previously had one.

Repeat C-Sections

• High recurrence rate: 80% of women who have one C-section will likely have subsequent C-sections, many of which may be unnecessary due to scarring concerns.
• Guidelines from Society of Obstetricians and Gynaecologists of Canada: Women with previous C-sections should be encouraged to attempt vaginal birth before opting for surgery, yet adherence to these guidelines is low.

Regional Variations in C-Section Rates

• Disparities across Canada: C-section rates vary significantly by region:
  • Newfoundland and Labrador: 31.5%
  • Manitoba: just over 20%
  • Nunavut: 6.9%
• Influences on rates: Differences in practitioner responses to complications like dystocia can cause inconsistent C-section rates among professionals.

Practitioner Attitudes and Evidence Gaps

• Misconceptions among healthcare providers: Some practitioners hold incorrect beliefs about C-sections, believing they can prevent issues such as urinary incontinence, despite a lack of evidence.
• Trends: Newer generations of obstetricians may favor medical interventions over traditional vaginal births, potentially influencing C-section rates.

Conclusion

• Issue Outlook: Canada's high C-section rates pose risks and incur costs; it's essential to focus on improving practices based on clinical evidence rather than shifting the responsibility to mothers' preferences. Most women prefer natural childbirth when possible.

References

1. Canadian Institute for Health Information. (2010b).
2. Public Health Agency of Canada. (2008).
3. Organisation for Economic Co-operation and Development. (2009).
4. Liu et al. (2007).
5. Miesnik & Reale. (2007).
6. Negele et al. (2004).
7. Canadian Institute for Health Information. (2010a).
8. Hanley et al. (2010).
9. Public Health Agency of Canada. (2009).
10. Declercq et al. (2006).
11. Mazzoni et al. (2011).
12. Society of Obstetricians and Gynaecologists of Canada. (2005).
13. Hanley et al. (2010).
14. Zhang et al. (2010).
15. Klein et al. (2009).
16. Klein et al. (2011).
17. Betrán et al. (2007).