Almost 1 in 4 Canadian
Babies Delivered By Caesarean

Canada's caesarean birthrate has hit an all-time high, with the surgery being used to bring almost one in four infants into the world, a report by the Canadian Institute for Health Information shows.

The report released by the independent, non-profit institute found that C-sections accounted for 22.5 per cent of in-hospital deliveries during 2001-2002, a jump from 15 per cent of all deliveries in 1979-1980.

Kira Leeb, manager of health reports for the institute, says there are "a multitude of reasons" why caesarean rates have risen: more women are having babies at an older age; the number of higher-risk pregnancies has spiked; and there has been a shift away from family physicians performing deliveries.

"All those sorts of things are likely driving the increase in the rate," Leeb said Wednesday.

A high number of C-section births at one time raised alarm bells, with fears that more were being performed than necessary. But Leeb said the all-time-high rate may merely reflect that caesareans have become more appropriate because of changes in the risk-profile of many births, she said.

With more women choosing to have babies later in life, the chance of complications rises, as it does in multiple births, a growing phenomenon with the boom in reproductive technologies such as in-vitro fertilization, she said.

Canadian moms are getting older, the report shows. In 1991, 34 per cent of babies in Canada (excluding Ontario) were born to women 30 and over. By 2000, that figure had jumped to 42 per cent.

As well, a declining number of family physicians performing deliveries has contributed to alterations in Canada's birthing landscape.

"I think what we're certainly seeing is one thing - a shift in birthing trends in Canada . . ." Leeb said. "But we are also seeing a change in the scope of practice of people who are involved in obstetrical care.

"Family physicians aren't doing as much, but obstetricians are doing a bit more. We also have the midwives being thrown into the mix, and midwifery in Canada is becoming a bit more popular." About three per cent of new mothers reported using midwives for prenatal care.

The report, entitled Giving Birth in Canada: Providers of Maternity and Infant Care, shows that fewer than 19 per cent of family doctors across Canada billed for obstetrical services in 1999, compared with a little more than 31 per cent 10 years earlier.

Obstetricians attended 61 per cent of vaginal births and 95 per cent of all caesarean births in 2000, the report says.

There is no one reason why fewer family physicians are delivering babies, but in studies, newly graduated general practitioners cite several reasons for avoiding obstetrics, among them lack of confidence in their delivery skills, fee structures and fear of malpractice suits.

Dr. Carolyn Lane has taken a path that runs counter to the prevailing trend: 13 years ago, she gave up family practice to focus solely on obstetrics and newborn care.

"As that is my role, I can't understand why family physicians don't want to do obstetrics - and yet I can," said Lane, one of six doctors at the Low Risk Maternity Clinic in Calgary. "It's very demanding and we are under-doctored right now and demands on physicians are extremely high.

"And so obstetrics is one of those things you can drop to try to keep some sanity in your life. For me, I dropped my family practice because I couldn't give up the obstetrics. I couldn't do it all. That's what family physicians are finding - they can't do it all."

Wednesday's report shows that general practitioners in the western provinces and the territories are more likely to deliver babies than those in Central or Atlantic Canada, and small town-rural area family doctors are more likely to attend deliveries than their urban counterparts. Twenty-seven per cent of rural doctors reported delivering babies in 2001, compared with 12 per cent in urban areas.

When it comes to C-sections, Lane isn't sure what to make of the record-high numbers.

"The problem is, we don't know what the ideal rate is," she said, noting that society's expectations and demands also play a part in birthing.

"In the past, I believe women felt very strongly that they wanted to avoid caesarean sections, yet there is a certain segment of our population that think they're a pretty good way to go.

"I think we need to reinforce how normal childbirth is and support women in normal childbirth and not turn it into a technological event."

Leeb, a Toronto mother of three young children, said keeping track of caesarean rates and other birthing data is vital for Canada's health-care system.

"The important thing to really look at is the change in scope of practice of the providers of maternity and infant care and how that change . . . is really going to have an impact on who delivers babies in the future," says Leeb, adding that federal and provincial governments must "make sure those changes are planned for . . . so that Canadians continue to have healthy babies."

Reference Source 89

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