C sections continue rising

More than a third of children born in British Columbia are delivered by caesarean section — the largest proportion in Canada. The national average is 28 per cent, while Manitoba and Saskatchewan have scores in the low 20s, and the Northwest Territories are at 18.5 per cent.

Just as troubling, the pace keeps accelerating. In 2000, 24.7 per cent of B.C. mothers had C-section deliveries. Last year, the percentage was 35.3 per cent.

That places us neck and neck with Italy and South Korea for third highest in the world. The internationally recognized ideal is between 10 and 15 per cent.

This surge in C-section rates is not confined to B.C. It is a global phenomenon.

Partly, that’s because women now tend to have their first child later in life. That can make a normal delivery more difficult.

In addition, fertility rates have fallen dramatically in western countries, with many couples choosing to have just one child. That tends to make expectant mothers more riskaverse, meaning they opt for a C-section delivery “to be on the safe side.”

And infant birth weights have climbed in recent decades. That’s also a consideration when choosing whether to have a traditional delivery.

However, while these factors help account for the growth in C-section rates worldwide, they do not explain why B.C. appears so far out of line.

One part of the answer is that home births aren’t counted in the national database, which looks only at hospital deliveries. But health authorities in our province place a priority on encouraging home births. We are far ahead of jurisdictions such as Ontario.

That makes our C-section rates, as a proportion of all births, look higher than they are.

In addition, provinces and territories with relatively large First Nations populations tend to have low C-section rates. That’s because many Indigenous women give birth to their first child in their late teens — the biologically ideal age. They also are likely to have more than one child.

In most cases, a C-section is not needed because the mother is young and healthy, and because one C-section tends to lead to another. That might explain why Manitoba, Saskatchewan and the Territories, with large Indigenous populations, have such low numbers.

It must also be said that the purpose of any obstetrics program is to deliver a healthy child. And here, with the exception of Prince Edward Island, B.C. leads the country.

Our infant-mortality rates are nearly 30 per cent below the national average, and well beneath the scores in Ontario and Quebec.

Nevertheless, it would be difficult to argue that B.C. can’t do better. With hospitals already under immense pressure, anything that encourages more mothers to choose traditional delivery would help.

And some progress has been made. Richmond’s hospital once had the highest percentage of C-sections in the province.

Staff found several causes. It turned out that admitting expectant mothers to hospital sooner than necessary increased the number of Csections.

And the practice of constantly monitoring the baby’s heart rate throughout labour had the same result.

Every little variation generated needless anxiety.

When changes were made in these and other policies, the hospital’s Csection rate fell to one of the lowest in the province, with no evidence of harm to mother or baby.

We need more of these innovations. If nothing is done to reverse the trend line, C-sections are well on the way to becoming the “normal” birth option, rather than the exception.

In short, we’re doing an excellent job producing healthy babies. But we need to restore natural childbirth to its traditional role.