Reading 1 Flashcards
is it true that c-sections are on the rise because mothers are asking for them?
no
are women have more c-sections than ever in Canada? Are other countries seeing this same trend?
yes
In 2008-09, more than one in four hospital deliveries were by C-section, a nearly 10% increase since 1995-96
Many countries are seeing the same trend.
But is a high C-section rate a problem? After all, isn’t C-section a safe, life- saving procedure?
What risks do c -sections pose?
While surgical birth can be a lifesaver when it is medically necessary, it is not 100% safe.
Compared to vaginal delivery, C-sections pose greater risk of cardiac arrest, hysterectomy, infection, fever, pneumonia, blood-vessel clotting, and hemorrhaging4, 5 as well as risks for the baby.
Is it more expensive to deliver via c section in Canada? how much more does a first-time c-section typically cost?
How much money could Canada’s healthcare system sdave if the first-time rate of c-sections could be reduced to the WHO recommendation?
Yes. In Canada, a first-time C-section costs approximately $2,265 more than a vaginal delivery. Canada’s healthcare system could save close to $25 million if the rate of first-time C-sections, let alone repeat C-sections, could be reduced to the 15% recommended by the World Health Organization.
Do we know how many women in Canada choose c-sections? Do we know this info for BC?
No one knows how many mothers in Canada choose C-sections (inconsistencies in the national data make it impossible to tell) but the number is probably very low.
In British Columbia, where maternal choice is tracked, a recent study found that less than 2% of C-sections were done because the mothers requested them.8
What did a 2008 study on Canadian Maternity experiences reveal about what percentage of mothers request c sections?
What did most mothers who had a c-section indicate?
A 2008 survey on Canadian maternity experiences reported a higher (though still low) number: just over 8% of mothers requested C-sections, and most of these women had already given birth by C-section.9
A similar survey of U.S. mothers found that less than 1% of first-time Cesareans were done at maternal request without a medical reason.
Interestingly, most of the mothers who had a C-section indicated that it was their healthcare provider who made the decision.
What are the stats on women who report wanting a c section in the world?
A low rate of on-demand C-sections would not be a surprise given that most women say they don’t want them. A recent systematic review of women’s preferences found that, worldwide, only about 16% of women would choose to have a C-section.11 The number is even lower (10%) when you exclude women who have already had a C-section.
How many women who have had one c section will have another one? Are these procedures necessary?
Eight out of every 10 women who have had a C-section will have another one, and many of these procedures don’t need to happen.
Why do doctors perform repeat c sections?
What are the guidlines on this?
Doctors perform repeat C-sections to avoid tearing the scar left on the uterus from a previous C-section, a dangerous but uncommon outcome.
The Society of Obstetricians and Gynaecologists of Canada recommends that women with a previous C-section try a vaginal birth; if a woman is unable to safely give birth in this way, the option to perform surgery remains
Canada’s high rate of repeat C-sections persists in spite of these guidelines, pointing to a dissonance between evidence and practice.
What do the variable regional rates suggest about the chance that someone will get a c-section in Canada?
The variable regional rates across Canada suggest that the chances that a woman will give birth by C-section depend on where she lives.
What are the c section rates according to different geographic areas?
In Newfoundland and Labrador, for example, the rate was highest in 2008-09 at 31.5% of births, whereas in Manitoba the rate was moderate at just over 20%. In Nunavut it is only 6.9%.1 Some variation should be expected, given how the demographics differ from place to place, but these numbers also point to inconsistent decision-making on the part
of practitioners.
What is one of the biggest factors for the C-section variation problem in Canada? Why might a doctor act too fast?
Researchers examining the variation problem in British Columbia found that one of the biggest contributors was how practitioners responded to dystocia, the term used for an extremely difficult birth
Some obstetricians performed many C-sections for this reason and some did not. It isn’t likely that the rates of dystocia would be so different across the province; it is more probable that some doctors turn too quickly to the surgical solution. A recent review of U.S. Cesarean practice found that many doctors were abandoning labours far too soon because of dystocia.14 They seemed to be out of step with recent evidence indicating that it can take longer for many women who have previously given birth to go into labour. They were also out of step with practice guidelines.
What does the researhc show about practictioner’s attitudes towards maternity care?
There are likely to be many more instances where a divergence between maternity care practice and science affects the C-section rate. Recent research into practitioners’ attitudes toward maternity care shows that many hold views about C-sections that contradict the clinical evidence. For example, 25% of obstetricians, family physicians and nurses believe that a C-section will prevent urinary incontinence or sexual problems despite a lack of supporting evidence.15 Many also believe that a C-section is as safe as a vaginal birth, though the science shows definitively that it is not. The newest generation of obstetricians in particular holds negative views of natural childbirth and a predilection for C-sections along with other medical interventions
What were the conclusions of this reading?
Unnecessary C-sections lead to unnecessary harm and expense, so we should find ways to curb them. We can look abroad and compare our rates with other nations and the effect different rates have on neonatal and maternal health outcomes.
One thing is clear, the spotlight must be turned away from the choices mothers make and shone on the decisions of their healthcare providers. Addressing the gap between birthing practices and the best available clinical evidence will reduce the number of C-sections much more effectively than policies aimed at changing women’s preferences. Most of them would rather give birth the natural way.
