The number of Caesarian births across Canada is becoming a growing concern, say health care experts, but one Toronto hospital has a plan in place to combat the trend. And it’s working, says a new study on a C-section reduction strategy employed by Markham Stouffville Hospital in Ontario.
Canada’s C-section rate has jumped over the past two decades, from 17 per cent of all births in 1995 to 27 per cent by 2013. The trend has been driven by a change in fertility patterns, where more women are giving birth later in life (and having fewer children) and birth weights have also climbed, making vaginal delivery more difficult.
According to the Canadian Institute for Health Information, women under the age of 35 delivered by C-section at a rate of 17 per cent in 2014-2015, as compared to 23 per cent for first-time mothers over 35, while another Ontario study found that upwards of 43 per cent of women over the age of 40 had C-sections.
Births later in life come with greater risks for health conditions such as obesity and gestational diabetes, which can increase the likelihood of surgical birth. But the rise in C-sections has also been fuelled by the perception that surgical births are safer than vaginal births along with worries about the pain and trauma associated with vaginal birthing.
Yet, there are risks associated with surgical births, as well. Women who have C-sections are more likely to need blood transfusions, to experience ruptured uteruses, unplanned hysterectomies, longer hospital stays and ICU admission.
“For years and years, maternal mortality in childbirth was going down, but now it’s going up for the first time, almost certainly in major part due to the increase and overuse of Caesarian section,” says Michael Klein, emeritus professor of family practice and pediatrics at the University of British Columbia, in Today’s Parent.
But resisting the C-section trend is possible, as witnessed at Markham Stouffville Hospital, where in 2010 health care practitioners developed the CARE (CAesarian Reduction) strategy aimed at lower the rate of C-sections among low-risk women at the hospital.
The CARE strategy includes a public education component on the benefits and risks of C-sections and a targeted campaign to inform women about the option of vaginal births after a previous C-section, something many women are unaware of as an option. As well, the hospital made changes to its policies surrounding inductions, encouraging physicians to wait longer after due dates before artificially trying to bring on labour.
Researchers from the University of Ottawa and McMaster University in Hamilton recently published a study on Markham Stouffville’s approach, finding that the CARE strategy reduced the rate of C-sections, from 30.3 per cent of women in 2009-2010 to 26.4 per cent in 2012-2013, a 3.9 per cent difference. The change is significant, the researchers say, as virtually no change in C-section rates was observed during the same time period at a control group of hospitals in Ontario.
“The present study provided an example of an innovative strategy that was associated with lowered rates of CD and other medical interventions during birth among healthy pregnant women,” say the study’s authors.
The research is published in the International Journal of Gynaecology and Obstetrics.