While Canada’s in-hospital birth rate continues to fall, an increasing proportion of women are delivering babies via caesarian section, a new report from the Canadian Institute for Health Information (CIHI) states.
“When we look at C-section rates, we see that they’re increasing moderately in recent years,” Greg Webster, CIHI’s director of Acute and Ambulatory Care Information Services, told CTV News. “And most significantly, we see substantial variation in C-section rates across the country.”
According to CIHI data, with more than 103,000 C-sections performed in 2016-2017, they continue to be the number one inpatient surgical procedure in Canadian hospitals, followed by knee and then hip replacements. With more than 366,000 childbirth hospitalizations in Canada recorded in that same period, that means that nearly one third of Canadian women are now giving birth through an abdominal incision. The growing C-section trend, CIHI’s data shows, is not slowing.
Just over 28 per cent of hospital births in Canada were performed via C-section in 2016-2017, compared with 26.7 per cent in 2007-2008 — an increase of 1.5 per cent. C-sections were most common among mothers aged 35 and over.
C-section rates also vary widely between provinces and territories. The lowest rate in 2016-2017 was recorded in Northwest Territories at 18.5 per cent, while nearly double that, the highest rate was recorded in British Columbia at 35.3 per cent. Newfoundland and Labrador had the second highest rate at 30.3 per cent, followed by Alberta (29.8 per cent), Prince Edward Island (29.6 per cent), Ontario (28.4 per cent), Nova Scotia (27.2 per cent), New Brunswick (27.6 per cent), Quebec (25.1 per cent), Yukon (24.9 per cent), Manitoba (23.4 per cent) and Saskatchewan (23.4 per cent). No data is available for Nunavut. This is occurring as the overall hospital birth rate in Canada dropped from 112 per 10,000 people in 2007-2008 to 102 per 10,000 in 2016-2017.
The reason for the increasing rate of C-sections in Canada remains unclear, and so too do the regional differences.
“We’re not surprised by the results because there has been substantial variation for many years in C-section rates,” Webster said. “However, the fact that there’s persistent variation with little understanding as to why (there is) such variation — that is surprising and we think an opportunity for further investigation.”
Personal choice and convenience may play a role, experts say. So too could the rising average age of new mothers. C-sections are also routinely used when a woman is giving birth to more than one baby or in cases where a baby or mother is at risk of complications. Preterm infants, as well as those that are small for their gestational age, could also lead to the procedure.
With obesity becoming more prevalent in Canada, doctors say this could also help explain rising C-section rates as obese mothers often have more issues with natural childbirth.
“The uterus doesn’t contract as well, labour is slower, they have a higher need to be induced, for example, which can lead to caesarian sections,” Dr. Jon Barrett, who heads the maternal-fetal medicine program at Toronto’s Sunnybrook Research Institute, explained to CTV News. Barrett also sits on the board of directors of The Society of Obstetricians and Gynaecologists of Canada.
“In many, many studies we have done here in Ontario, obesity is an independent risk factor for the risk of caesarian section,” he said.
C-sections, Webster notes, also cost the health care system nearly twice as much as natural births — and they also come with increased risks to both mothers and newborns. According to Webster, the average cost of a C-section in Canada is $4,033 and generally includes a three-day hospital stay. Natural births, on average, cost $2,569 and generally require only two days of hospitalization, Webster said.
“This is now the commonest inpatient surgery,” Barrett added. “We have to make sure we’re doing it for the right time and the right place and to the right mom with the best outcome.”