C-section rate rises, despite lower overall birth rate: report

TORONTO — A higher proportion of Canadian women are giving birth by caesarean section, even while the overall rate of in-hospital births across the country is declining, says a report released Thursday.

The report from the Canadian Institute for Health Information (CIHI) shows there were more than 103,000 C-sections in 20162017, making them the most commonly performed in-patient surgical procedure, followed by knee- and hip-replacement operations.

So what’s behind the rise in C-section rates, given that there’s been a push over the years to pare back the number of these procedures whenever possible?

“We don’t know for certain, there are a number of factors that can contribute to the increasing rates, one being that the average age of mothers giving birth is going up,” said Greg Webster, CIHI’s director of acute and ambulatory care information services.

Overall, the proportion of births in Canadian hospitals performed by C-section rose to 28.2 per cent in 2016-2017, from 26.7 per cent in 2007-2008, said CIHI. At the same time, the hospital birth rate continued to decline, dropping to 102 per 10,000 population in 2016—2017 from 112 per 10,000 population in 2007— 2008. Giving birth was the most common reason for hospitalization in Canada, with about 366,000 births in 2016-2017. The average length of hospital stay for a vaginal birth was just under two days, with an average cost of $2,569, while women who had C-sections were admitted for about three days, with that stay costing $4,033 on average.

CIHI found there were dramatic variations in C-section rates across the country. British Columbia topped the list with 35.3 per cent of deliveries being done by caesarean, followed by Newfoundland and Labrador at 30 per cent. The Northwest Territories had the lowest C-section rate at 18.5 per cent, with Manitoba and Saskatchewan next-lowest at 23 per cent each.

The CIHI study cannot explain why B.C.’s rate is so high, but “the data provide an opportunity to see variations so regions and provinces and territories know where they are relative to their neighbouring provinces and territories,” he said. “And then with a concerted effort the data can be analyzed in more detail to try to tease out what are the factors that make sense clinically for higher and lower rates in different regions.”

There are a number of reasons why doctors might perform a caesarean, including pregnancies where the mother or baby are at risk for complications. Pre-term infants and those small for their gestational age can lead to a C-section, as can a woman’s preference.

“In some cases, some Caesareans are done when there was an equally appropriate natural birth opportunity as well,” said Webster. “Each province and territory is different in terms of its rural and urban nature, how services are organized and the needs of the individual patients.”