Some obstetricians in Ontario are reviewing their delivery room practices with an eye to reducing Caesarean section rates, which may be in an expectant woman's best interest as well as a hospital's bottom line.
In 2012, the national C-section rate was 27.2 per cent, according to the Canadian Institute for Health Information, up from 18.7 per cent in 1997.
For three decades, the "ideal rate" for C-sections was considered to be between 10 per cent and 15 per cent, according to the World Health Organization.
In Canada, C-section rates have risen for a variety of reasons, including women giving birth at older ages.
At Markham Stouffville Hospital, the obstetrics department was over budget, obstetrics and gynecology chief Dr. George Arnold recalled. Faced with service cuts, he looked for alternatives.
"Can we reduce our section rate in an effort to not only provide the best care we can to the patient but to be fiscally responsible as well," Arnold asked.
Over four years, Arnold's department reduced its C-section rate from 29 per cent to 23 per cent.
Until the budget crunch, Arnold said caregivers had no reason to question C-section rates since they were providing excellent care with good outcomes for mothers and infants.
To reduce its rate, the hospital's delivery staff focused on two reasons their rates were high:
- Women were being induced sooner than they needed to be.
- Women who had a C-section for their first child and continue to have the surgery for the child's siblings. The alternative is a vaginal birth after C-section or VBAC.
Arnold will head an Ontario government task force to look at issues surrounding C-section rates. So far, a Health Quality Ontario panel has reviewed the literature on induction rates.
Other specialists in the province and beyond are concerned about attempts to chase a specific number of C-sections. Earlier this month, the World Health Organization raised a similar point in a statement calling for an internationally-accepted classification to be adopted to monitor and compare C-section rates across countries and regions.
"You need to compare the planned vaginal deliveries with all their complications, all their outcomes including the emergency Caesareans versus elective Caesarean sections," said Dr. Magnus Murphy a gynecologist in Calgary. "If you do that then the whole thing changes."
For Lisa Zeltzer of Toronto, the issues come down to what makes sense for an expectant woman and her baby.
Two weeks ago, Zeltzer delivered her daughter, Madeline, vaginally after giving birth to her first, Charlie, by C-section.
"I had a very quick, successful natural VBAC," Zeltzer said. "Exactly how I wanted it the first time."
Zeltzer said she'd support women in whatever they chose is right for them.