0
0
The Canadian Institute for Health Information (CIHI) has recently updated its interactive tool, “Your Health System,” offering valuable insights into health-care data across Canada. Among the measures reviewed is the “low-risk” cesarean rate, which tracks the number of first-time mothers who undergo a cesarean after laboring with a single baby in their first pregnancy. With this data, CIHI compares provincial rates to the national average of 17.9%, highlighting that Alberta (20.8%) and British Columbia (24.5%) fall “below average” in their cesarean rates.
The message is clear: lower cesarean rates are “desirable.” However, this statistic oversimplifies the complexities of childbirth and medical care, failing to capture the nuances that shape individual clinical decisions.
Clinical Care: More Than Just Numbers
The low-risk cesarean rate tells us how many women in their first pregnancy experience a cesarean after spontaneous labor, but it does not consider the clinical reasons behind the decision to intervene. For many women, a cesarean can be a life-saving procedure, especially in the face of unforeseen complications such as fetal distress, obstructed labor, or issues related to high infant birth weights.
It also overlooks the broader context of rising maternal age—currently averaging 31.7 years in Canada—which carries higher risks, including pre-existing medical conditions and pregnancy complications. Modern advancements in fetal monitoring have made it easier to detect potential problems during labor, and as a result, cesareans are sometimes necessary to ensure the safety of both mother and child.
CIHI’s focus on vaginal birth as the “expected” outcome ignores the reality that childbirth is inherently unpredictable. Parents expect safe, healthy deliveries, and cesareans are an important tool for obstetricians to meet these expectations.
Patient Autonomy and Outcomes Matter
The well-being of mothers should also be a priority. Recent research revealed that Canada has the highest rate of severe injuries to the pelvic floor from the use of forceps and vacuum-assisted deliveries among 24 high-income countries. These injuries can lead to long-term health issues such as urinary and fecal incontinence and pelvic organ prolapse.
In this context, rising cesarean rates may actually be an indicator that more mothers are choosing cesareans to avoid these complications, which are not always preventable through vaginal delivery. The principles of patient-centered care should prioritize the choices and well-being of individuals, especially when avoiding instrumental deliveries could reduce the risk of permanent damage.
A one-size-fits-all policy that pushes for lower cesarean rates, without considering individual patient needs, goes against the concept of informed consent and autonomy. The landmark Montgomery Supreme Court ruling in the United Kingdom stressed that maternal satisfaction and the informed decision-making process are more relevant measures of success than any statistic about cesarean births.
Lessons from the UK: Reassessing Cesarean Rate Targets
CIHI’s focus on reducing cesarean rates echoes similar efforts in the United Kingdom, where for years, hospital staff and safety inspectors pushed for lower cesarean rates. This was largely driven by concerns about the high costs of cesarean births. However, this focus on reducing cesareans resulted in delayed interventions, leading to tragic outcomes, including the deaths and serious injuries of mothers and babies who were deprived of necessary cesareans during “low-risk” pregnancies.
The UK’s multi-billion-dollar litigation costs from these incidents eventually forced the government to reevaluate its approach. The growing concerns in Canada about rising litigation and the long-term costs of pelvic floor damage suggest that a similar reckoning may be on the horizon here.
A Patient-Centered Perspective for Health-Care Metrics
CIHI has acknowledged the need for better access to cesarean births in remote areas of Canada, where healthcare resources are often scarce. However, its blanket stance that “lower rates are desirable” needs to be reconsidered, especially as the national “normal childbirth” policy that it still references is now recognized as outdated for clinical purposes.
To truly improve health outcomes and guide the evolution of Canada’s healthcare system, CIHI must adopt a broader, more patient-centered approach to reporting childbirth metrics. This should include comprehensive data on women’s reproductive health beyond just childbirth—taking into account conditions like pelvic floor disorders, endometriosis, infertility, and uterine bleeding.
Women are not merely vessels for childbirth—they are complex individuals with diverse health needs that extend far beyond delivery. Canada’s healthcare system should reflect this, with reporting that addresses these unique aspects of women’s health.
The conversation about cesarean rates is more than just about numbers; it is about recognizing and respecting the full spectrum of women’s health.
