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B.C. tops country in caesarean-section rates: federal report
A post-doctoral researcher at UBC found that although medical evidence shows most women who have a C-section in their first delivery can safely deliver a subsequent baby vaginally, only 20 per cent choose to do that.
About 40 per cent of women delivering babies in the Fraser Health region have caesarean sections, contributing to B.C.'s distinction as the C-section capital of Canada.
A new report on hospitalizations, surgeries and childbirth indicators released Thursday by the Canadian Institute for Health Information (CIHI) shows that just as in previous years, B.C. again leads the country with an average caesarean section rate of 35.3 per cent, up from 31.3 per cent in 2007/08. The national average is 28.2 per cent, up slightly from the previous year. The data is based on births in 2016/17.
C-sections have been associated with three times higher risk of maternal death, five times higher rate of wound infections and two times as many anesthetic complications, compared to vaginal births, according to a Canadian study. They also cost the health system 65 per cent more, mostly because of three-times longer hospital stays. The World Health Organization has long recommended that caesarean delivery rates not exceed 10 to 15 per cent of live births. A more recent study in the Journal of the American Medical Association pegs the optimal rate at 19 per cent.
Several years ago, a B.C. Women's Hospital leader, Dr. Jan Christilaw, said the high C-section rate was "not something we can be proud about in this province."
Hospitals in the Fraser Health region had the highest C-section rates in B.C. and while the report doesn't delve into causes, Nicole Loreti, a CIHI program lead, said reports in medical literature indicate there are numerous reasons: maternal preference, doctor's practice styles, maternal age and health and whether C-sections were done for earlier births since women will often have repeat operations rather than attempting to deliver vaginally for their subsequent pregnancies.
Tasleem Juma, spokeswoman for Fraser Health, said the report will be used to "improve the quality and safety of the care" provided to maternity patients.
"In addition, as part of our work to reduce the C-section rate, we recently hosted a provincial workshop where people shared learnings to improve care and reduce the number of C-sections. This workshop brought together teams of practitioners from five hospitals throughout B.C. to highlight successful strategies to promote vaginal birth."
Dr. Brenda Wagner, co-president of the B.C. Society of Obstetricians and Gynecologists, said she can't speak to the Fraser Health scenario because she delivers babies in Richmond. But she said practices often become ingrained until there is a specific mission to do things differently. In Richmond, which used to have a higher C-section rate, health professionals collaborated to do things differently. Nurses, midwives, family doctors and specialists all became champions of vaginal deliveries and that ended up lowering the C-section rate to just under 30 per cent from 33 per cent.
Tamil Kendall, interim provincial executive director of Perinatal Services B.C. , said while C-sections can be life-saving for both mothers and babies and are often necessary, the agency has focused on giving women and their health providers more information to promote vaginal deliveries. Last year, it began a partnership with a Vancouver Coastal Health researcher who surveyed women and health care providers to find out why B.C. has a high C-section rate. Sarah Munro, a post-doctoral researcher at the University of B.C., found that although medical evidence shows that the vast majority of women who have a C-section in their first delivery can safely deliver a subsequent baby vaginally, only 20 per cent choose to do that.
She found out that is due to miscommunication and misinformation from friends and family.
"They frequently make up their minds about repeat c sections before they even have a conversation with their (doctors)," she said. And medical providers don't correct the "misperceptions" or provide women with different evidence often because of time pressures during medical visits.
Munro and her collaborators have created an interactive online patient decision-making tool to give women more information. It's called My Next Birth but it is not yet available to pregnant women since it's still in pilot testing. The web-based tool will provide the most current information about childbirth choices and help women generate a report about their fears and values that they can then share with their health providers.
Munro said C-section rates can be influenced by a complex combination of factors including doctors scheduling them if they are concerned about hospital resources not being available at the time of delivery. A case in Abbotsford involving the death of a baby during delivery highlighted the fact that operating rooms are not always available if needed. A scheduled C-section may take the uncertainty and anxiety out of the equation.
C-sections are by far the most common surgical intervention conducted on patients admitted to hospitals, followed by knee and hip replacements. Across Canada, 103,425 caesarean sections were done in 2016/17, out of a total of 366,684 women who delivered babies in hospitals, either vaginally or via C-section.
pfayerman@postmedia.com
twitter.com/MedicineMatters
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Black Woman Arrested on London Train Assaulting Couple Throwing Food
Source: https://vancouversun.com/news/local-news/b-c-tops-country-in-caesarean-section-rates-federal-report
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