Caesareans: routine but not without risks
By the Canadian Institutes of Health Research
Formerly used in medically urgent situations only, Caesarean sections are now routine. Canada is not alone in this new trend. Obstetricians around the world are performing an increasing number of Caesareans.
World Health Organization1 numbers show rates of C-sections almost doubling in the last decade, especially in high-income countries such as Canada.
"The increase in Caesarean rates observed over recent years in North America is not associated to better health outcomes for the mom or the newborns, as we could have thought", said Dr. Emmanuel Bujold, a researcher at the Université Laval. "In fact, there is growing evidence suggesting that the increase in Caesarean rates may have more long-term negative impacts on the mom and the child than any short- or long-term positive impacts."
Caesareans may be common practice, but they are not without risks. Many Canadian studies show that planned Caesareans can lead to an increase in serious postpartum complications for the mother such as hemorrhage, cardiac arrest, an adverse effect on fertility, abnormal implantation of the placenta in subsequent pregnancies, infections, difficulty breastfeeding, and even death. For the baby, possible risks associated with a Caesarean include injuries caused by surgical instruments, respiratory problems in the immediate newborn period, as well as chronic problems such as asthma, diabetes and allergies. Fortunately, most C-sections go well and without problems.
Although no exact numbers are available on the number of women requesting Caesareans, a researcher from the Université de Montréal believes one reason behind elective Caesareans may be women's lack of confidence in their ability to give birth naturally.
Dr. William Fraser, whose work is supported by the Canadian Institutes of Health Research, says the decision to have an elective Caesarean delivery should not be taken lightly.
"Women should be aware of the rare but very serious risks associated with it. When I speak to patients, I make an effort to listen to their concerns", added Dr. Fraser. "Are they afraid of the pain of a vaginal delivery, do they have particular apprehensions related to their delivery, worries about the safety of their infant, or have they heard about bad experiences from family members? Or have they simply been influenced by a high-profile personality who elected to have a Caesarean as a personal choice."
However, Dr. Fraser stresses that all obstetrical services should have the capacity to perform Caesareans. "In some cases, it's a life-saving surgery that is absolutely required".
The Canadian Institutes of Health Research is funding a study in Québec where researchers are working directly with health care professionals to provide more information to patients about different delivery methods and to ultimately reduce the rate of Caesareans.
1WHO