Rising C-section rates add risks during childbirth and place excess strain on the healthcare system, warn Canadian obstetricians

More than one in four children now born by Cesarean section

Canada’s obstetricians are warning today that the percentage of babies born by Cesarean section is at an all-time high and continues to rise.1 This trend, says the Society of Obstetricians and Gynaecologists of Canada (SOGC), is exposing mothers to increased risks during childbirth and for subsequent pregnancies, and is placing excess strain on the healthcare system.

In light of these rising rates, the Society is urging Canadian healthcare professionals and women to opt for C-sections only when medically necessary.

“While the individual risk for a woman having a C-section is very small, the rising rate is certainly a concern,” said Dr. Guylaine Lefebvre, President of the Society of Obstetricians and Gynaecologists of Canada. “We fear that there may be an emerging trend towards more scheduled childbirth and routine intervention. We need to be sure that C-sections are not driven by convenience, that interventions are medically indicated, and that the safety of a woman and her baby are the driving factors in these decisions.”

Many factors contribute to Canada’s rising C-section rate, including the country’s rising obesity rates and the trend for women to delay pregnancy until later in life. However, other contributing factors are not as clearly understood, such as the effects of the current shortage of maternity care providers or the role of changing patient and physician attitudes about intervention in childbirth.

Currently, more than one in four children is born by C-section. From 1993 to 2006, Canada’s C-section rate increased from 17.6 percent up to 26.3 percent.1 For Canada – one of the safest places in the world to give birth – this rising rate presents a concerning trend for the future.

For a low-risk childbirth that is progressing normally, C-sections require substantially longer recovery times and present greater risks of complications such as infection, bleeding, scarring, chronic pelvic pain, and damage to the intestines or bladder. C-sections also increase the risks during subsequent pregnancies, making a repeat C-section more likely. In 2007, research by the Canadian Perinatal Surveillance System found that elective C-sections have higher risks of anesthetic complications, major infections, obstetrical wound, and cardiac arrest. The study also notes that women who had an elective C-section were more likely to require an immediate hysterectomy due to bleeding.2

"These additional C-sections place excess burden on a maternity care system that is already facing a shortage of obstetricians and other health professionals,” said Dr. André Lalonde, SOGC Executive Vice-President.

The Society of Obstetricians and Gynaecologists of Canada is actively working to provide continuing education for Canadian healthcare professionals on best practices relating to Cesarean section. In addition, the group is seeking collaboration and support from its government and health partners to further explore the root causes of these rising rates, to identify potential solutions, and to properly assess the implications for the safety of childbirth in this country.

References
1.  Canadian Institute for Health Information
Giving Birth in Canada: Regional Trends From 2001–2002 to 2005–2006.
http://secure.cihi.ca/cihiweb/en/downloads/Childbirth_AiB_FINAL_E.pdf
2.  CMAJ
Maternal mortality and severe morbidity associated with low-risk planned Cesarean delivery versus planned vaginal delivery at term
http://www.cmaj.ca/cgi/reprint/176/4/455.pdf

Source: http://www.sogc.org/media/advisories-20080625_e.asp