Now is the time to curb rising C-section rates in Canada
C-sections can be life saving for both mothers and newborns. But each C-section is also a major operation, with significantly more risks
Even during the pandemic, labour and delivery are the most frequent reasons for hospitalization in Canada, with over 350,000 births per year. That’s happy news. But of these births, nearly one third are by caesarean section (C-sections). That rate is far too high — and rising.
C-section is the procedure to deliver a baby involving an incision in the mother’s abdomen and uterine wall, recommended when the baby’s or mother’s lives are at risk from a vaginal delivery. Nearly 105,000 C-sections take place each year, making it the most common hospital-based surgery in Canada.
The pandemic has underscored the importance of using our limited healthcare resources wisely. Yet we know a significant proportion of C-sections are being done when they may not be necessary.
C-section rates have more than doubled in the past 25 years. Even accounting for some changes in the child-bearing population over this time such as mothers having children later and higher rates of obesity and chronic diseases, we know this shouldn’t be driving such a sharp increase. So why is this happening? C-sections can be life saving for both mothers and newborns. But each C-section is also a major operation, with significantly more risks than a vaginal birth — including higher rates of infection, hemorrhage and death for the mother. As well, after a C-section, there is a scar on the uterus, which has implications for future pregnancies and labour.
As a past and the incoming president of the Society of Obstetricians and Gynecologists of Canada (SOGC), we are committed to raising awareness about the harms of unnecessary C-sections.
As part of the Choosing Wisely Canada campaign, which is an organization dedicated to reducing unnecessary tests and treatments, the SOGC released recommendations for all clinicians involved in birth, including obstetrician gynecologists, family physicians and midwives.
Research suggests a significant part of the overuse of C-sections often occurs when it appears mothers are not progressing in early labour. Labour has both a latent or beginning phase, followed by an active phase. The transition from latent to active labour can take time; in some cases, many hours. For healthy women with a single pregnancy, the optimal management during this phase is to allow them time to progress while offering supportive care including pain relief and rest. Most women can then enter active labour and most proceed to vaginal delivery. Deciding to do a Csection may often relate to providers’ and/or patients’ reluctance to wait for active labour. Our recommendation urges physicians to rethink their practice for the latent phase of labour and wait and see if a patient can safely deliver vaginally.
Now more than ever, it is important to use health care resources wisely. Thinking twice before undertaking the most common surgical procedure for the most common reason for hospitalization in this country is a great place to begin.
Dr. Margaret Morris is professor in the department of obstetrics, gynecology and reproductive sciences at the University of Manitoba and the president-designate of the Society of Obstetricians and Gynecologists of Canada. Dr. George Carson is clinical professor obstetrics and gynecology, University of Saskatchewan and past president of the society. The views in this commentary do not reflect the views of the SOGC.