Total Cesarean Rates by Reportable Health Region, Canada, 2005–2006

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Discussion of cesarean section data:

The total C-section rate in Canada in 2005–2006 was 26.3%, which is lower than the rate in the U.S. (29.1%) and Australia (29.4%) in 2004, though higher than the rate in England in 2005–2006 (23.5%). Similarly, the primary (18.6%) and repeat C-section rates (81.9%) in Canada in 2005–2006 were lower than the rates in the U.S. in 2004 (20.6% and 90.8%, respectively). The increase in the total, primary and repeat C-section rates in Canada is consistent with what has been observed globally. The rise in repeat C-section rates indicates that the proportion of women who have a vaginal birth after having had a C-section has decreased. This agrees with what has been observed historically and has been attributed to increases in elective repeat Caesarean deliveries. Increased C-section rates are associated with higher maternal age, lower parity and high pre-pregnancy weight. In Canada, the average age of mothers giving birth has increased, as has the proportion of mothers giving birth for the first time. Similarly, obesity rates among Canadian women have increased significantly. Changes in obstetrical practices, increased acceptance of obstetric interventions, low tolerance for fetal risk and potential medico-legal concerns may also account for the increase in C-section rates.

One issue that has garnered much debate is the influence of maternal requests for C-sections on the increasing rates. While it has been suggested that this might be more common among affluent women, no association between socio-economic status and C-section rates has been identified in Canada. Furthermore, a recent review of the literature on this topic found that the proportion of C-sections performed solely on the basis of maternal request was actually very low, and suggested that physicians’ perceptions of women’s views and physicians’ personal preferences may be factors in driving the rate upward.

Source: Giving Birth in Canada: Regional Trends From 2001-2002 to 2005-2006.