Question 1
A cesarean section or C-section is when surgery is used to deliver a baby instead of the normal way. In Canada, there has been a steadily increasing preference of this type of delivery over the past two decades according to data gathered by the Canadian Institute for Health Information (CIHI) ( Favaro & St. Phillips, 2018) . More than 103,000 Cesarean deliveries were performed in 2016-2017 alone and this makes this procedure the top cause of inpatient admission in Canadian hospitals. Considering that a total of 366,000 births were recorded in the same period, this means that a third of women prefer C-section ( Liu et al, 2004; Favaro & St. Phillips, 2018) .
Cesarean delivery has become a trend in Canada and many women opt for it despite having no complications that warrant surgical delivery. There are several reasons why women choose C-section over normal delivery. One of them includes anxiety that comes with virginal birth. One woman from Toronto says that she opted for surgery because she would have nightmares of tearing and episiotomies gone wrong (Kirky, 2016). Another factor influencing the preference of C-Section is that fertility culture has changed. More women in Canada are having fewer babies at a later age. Therefore, this increases the likelihood of a doctor recommending C-section to avoid complications ( Born, Konkin, Tepper, & Okun, 2014) . According to statistics released by the Canadian Institute of Health Information, 17% of first time mothers under the age of 35 delivered through C-section as compared to 23% of women over 35 between 2014 and 2015 (Kirky, 2016). Older women are also more likely to have complications such as obesity, diabetes and hypertension which may increase the need for surgical birth (Kirky, 2016). However, these complications are not enough to account for the disproportionate increase in the rates of C-sections.
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There is also an increasing availability doctors that are open to elective surgery. Although this is usually to increase their revenue as surgery is more expensive, it allows women to have C-section as an option. A woman also gets more control of their delivery plans as they can pick a day that is convenient for them to give birth with this method (Murphy, 2017). A woman can book surgery a few days before their due date if they want to and if the baby is past due, they can decide not to wait for nature to take its course.
Popular culture has also influenced how people view C-sections with women following the example of famous women they look up to. There is increasing worry over the preservation of the tension of the pelvic floor muscles and the vagina ( Favaro & St. Phillips, 2018) . Pop culture has popularized the idea of a woman remaining sexual even after giving birth and so women fear that virginal births will make them loose and undesirable. There is also the concept of the “precious baby” syndrome where mothers feel that the pregnancy they have may be the only one and that nothing should be done to risk the health of the baby. This especially affects women that have been trying to get pregnant for so long with no result (Kirky, 2016). Sadly, studies have concluded that C-section is not necessarily safer than normal delivery.
Many people say that the risks associated with elective cesarean delivery and the benefits of natural deliver are both exaggerated. However, it is difficult to ignore the small but significant decrease in still births attributed to C-sections. Canadian researchers have found that planned C-section poses a rare but higher risk of post-partum complications, reproductive system infections and hysterectomy than virginal delivery (Murphy, 2017). Besides, fewer babies die due to lack of oxygen when the mother goes on labor for too long. An increase in the weights of newborns due to nutritional changes has also made it more difficult to deliver normally and thus cesarean is necessary to help with this. Increased multiple pregnancies associated with late childbearing age and fertility treatment has also increased the likelihood of using C-section (Kirky, 2016).
The reason why the trend sticks and will continue to grow is because once a woman uses surgery for her first delivery, they will probably be recommended to do in subsequent pregnancies. This poses a problem because the procedure has been recorded to cause increased maternal mortality (Murphy, 2017). The fact that most women that opt for the C-section have no need for it and are rather misinformed about the pain and anxiety associated with pregnancy is also dangerous as it may mean that they place themselves in danger without enough knowledge of their actions. Deaths of infants born through surgery are higher at 1.77% per 1000 live births as compared to 0.62% for virginal deliveries in Canada, 2006 (Kirky, 2016). The latter is considered important for increased immunity in a baby as antibodies are passed to the baby as it passes through the birth canal.
Women are very open to suggestion and they often choose cesarean even when they know the health risks it may have on them in the future. It is a matter of weighing the options and deciding that for the situation they are in, that is the best choice for them. Women that come from traditional and family centered background will most likely choose virginal delivery while the career woman will most likely choose for convenience. Cesarean delivery is also not as safe as most people believe, especially for the mother. It poses a higher risk of developing hysterectomy, cardiac arrest, infection, fever, pneumonia, and blood-vessel clotting. It also presents several risks to the baby. The mother will also have to bear the scare of the surgery which women who do normal delivery often do not have to worry about.
C-sections are also less desirable as they are more expensive as compared to normal births. They also require more resources like an operating room, qualified Ob/ Gyn surgeons, anestheologists, nurses and equipment to effectively operate. In 2006, the estimated cost of a C-section in Canada was $4,600 while one spent $2,800 for a virginal delivery ( Born, Konkin, Tepper, & Okun, 2014) . An increase in the number of working women and the living standards of the working class may therefore be a reason why the rates of C-sections have increased; because more people can afford to pay for them. The Canadian healthcare system would save approximately $25 million if the rate of first-time C-sections, reduced to the 15% recommended by the World Health Organization.
Research also shows that most women do not want to have a C-section, especially for a second time. It is doctors who often make the choice to use this method for women by making them believe that it is the safest method to deliver (“ Myth: C-sections”, 2011) . In repeat cases, doctors will recommend a C-section to avoid tearing the scar left on the womb on the previous procedure when it contracts to let the baby out. Although the rapture of the uterus is a potentially dangerous situation, it is very rare. The Society of Obstetricians and Gynecologists of Canada recommends that women who have undergone a C-section try a vaginal birth (“ Myth: C-sections”, 2011) . This still leaves the option of C-section open just in case a normal delivery does not work. However, such recommendations are rarely followed.
One of the factors that affect how doctors respond to the issue of C-section is dystocia. This term refers to when a woman has a slow and difficult labor. Many obstetricians in Canada recommended C-sections for this reason for fear that the exhaustion and pain could be detrimental to the mother’s and baby’s health (“ Myth: C-sections”, 2011) . However, it is likely that some doctors rush into surgery even when the dystocia does not pose any perceivable threat. This has caused a trend of doctors being out of touch with evidence based practice on the subject where they do not follow the guidelines that have been scientifically proven to work.
The lack of evidence based practice has also led many practitioners to levitate towards views that support cesarean delivery. For instance, some believe that C-sections can help prevent urinary incontinence and sexual issues even though there does is no evidence to support this. Such beliefs are then transferred to patients who have put their trust in the practitioners’ judgment and leading to the spread of misconceptions that support the preference of C-section.
Although there is not clearly set boundary in regards to cesarean delivery, the World Health Organization has set the ideal rate for any country at 10 to 15 % of all births. The organization also recommends that doctors only allow C-section with the patient’s best interests in mind However, elective C-sections only account for about 2% of overall incidents (Kirky, 2016). This means that there could be bigger underlying causes of the increase in cesarean rates besides women choosing to use it.
Canada’s has an alarmingly high C-section rate especially among women under 35 and practical solutions should be sought to change this. This is shocking especially because most of these procedures are unnecessary and they may cause harm and expense to the patient. Women should not be allowed to make choices based of ungrounded assumptions as this may cause them to harm themselves of their babies in the process. Healthcare providers should instead take initiative and put the health of their patients over all other factors because they have the knowledge and skills to make the right decisions in these matters. The gap between clinical evidence and practice should also be addressed to ensure that only the most effective policies and practices are implemented in this field.
References
Born, K., Konkin, J., Tepper, J., & Okun, N. (2014, May 29). Pulling back the curtain on Canada’s rising C-section rate. Retrieved from http://healthydebate.ca/2014/05/topic/quality/c-section-variation
Favaro, A., & St. Phillips, E. (2018, April 19). While Canada's birth rate drops, C-section rates rise: report. Retrieved from https://www.ctvnews.ca/health/while-canada-s-birth-rate-drops-c-section-rates-rise-report-1.3891951
Kirky, S. (2016, April 5). Too precious to push ? shame, fear and the spike in C-sections: ‘It's not safer, but it's believed to be safer’. Retrieved from http://nationalpost.com/news/canada/doctors-encouraging-more-mothers-to-choose-delivery-by-cesarean-its-not-safer-but-its-believed-to-be-safer
Liu, S., Rusen, I., Joseph, K., Liston, R., Kramer, M. S., Wen, S. W., & Kinch, R. (2004). Recent Trends in Caesarean Delivery Rates and Indications for Caesarean Delivery in Canada. Journal of Obstetrics and Gynaecology Canada , 26 (8), 735-742. doi:10.1016/s1701-2163(16)30645-4
Murphy, L. (2017, September 20). Canada's C-section crisis: Why are rates so high? Retrieved from https://www.todaysparent.com/pregnancy/giving-birth/canadas-c-section-crisis-why-are-rates-so-high/
Myth: C-sections are on the rise because more mothers are asking for them. (2011, May 6). Retrieved from https://www.cfhi-fcass.ca/SearchResultsNews/2011/05/06/ab4a74cd-ffbc-427b-9995-7f7434a87a67.aspx
