C-section rate high at GTA hospitals
1 in 3 incidence at one site well over national average
A woman has more than a one in three chance of having a caesarean section if she delivers her baby at Lakeridge Health.
Across town at Trillium Health (now part of the newly merged Credit Valley Hospital and Trillium Health Centre), a woman has less than a one in four chance of having a C-section.
The findings by the Canadian Institute for Health Information (CIHI), exclude C-sections done because of premature or multiple births.
The World Health Organization suggests the C-section rate should be between 5 and 15 per cent, but very few Canadian hospitals hit that target.
“There are rates of 30 and 40 per cent in some hospitals. That’s staggering,” said Kira Leeb, CIHI’S director of health system performance.
Lakeridge president Kevin Empeysaid the hospital has been aware of their high C-section rate for a number of years and has taken measures to correct it.
“We asked the program to study and make changes in improvements and we didn’t have any success, so we changed the leadership in that service (Women and Children) late last fall and there is now new leadership,” he said.
The national average for C-sections is 26.94 per cent.
“There are rates of 30 and 40 per cent in some hospitals. That’s staggering.” KIRA LEEB CIHI DIRECTOR OF HEALTH SYSTEM PERFORMANCE
Nine of the 17 hospitals in the GTA that measure this indicator perform worse than the national average. GTA hospitals do even worse when it comes to repeat C-sections, with 16 of 17 performing more than the national average. In fact, this is where GTA hospitals rated worse in 21 clinical performance measurements assessed by CIHI.
CIHI looked at the number of women who delivered babies vaginally after previously having C-sections and found the national average is 17.46 per cent. The only GTA hospital that performed better than this was the Scarborough Hospital with 26 per cent of women delivering vaginally after a previous Csection. The poorest performers were Humber River Regional with a rate of 4.78 per cent, Rouge Valley at 6.7 per cent and Halton Healthcare at 7.7 per cent.
Well-educated women often are less willing to take risks if there are signs of trouble during labour.
These findings will no doubt serve as a wake-up call for hospitals, after the province recently warned it aims to only fund services supported by medical evidence.
Dr. Donna Stewart, chair of Women’s Health at the University Health Network, said there are numerous and complicated reasons behind high C-section rates. Women are having babies at an older age. And older, often well-educated women often ask more questions of their obstetricians and may be less willing to take risks if there are signs of trouble during labour.
“Importantly, there is fear of legal suits if babies are not perfect when born,” she said.
Meantime, there is more electronic monitoring which may identify fetal distress prompting a C-section, Stewart noted. As well, more complicated pregnancies that may require C-sections are referred to Toronto teaching hospitals.