Labour inductions
  • In British Columbia (BC), 27% of first-time mothers have their labour induced artificially. The overall rate for all mothers is 22% (1).
  • The World Health Organization recommends that no region should have rate of induced labour higher than 10%  (2,3).
  • Induction of labour almost doubles the risk of emergency C-section. In BC, 15% of mothers whose labours begin spontaneously have emergency C-sections, while as many as 26% of those who are induced have emergency C-sections.  For first time-mothers, induction increases the risk of emergency C-section from 22% to 38% (5).

C-sections

  • 33% (1 out of 3) of first-time mothers in BC have their babies delivered by C-section. The overall rate for all mothers is 30% (1).
  • The World Health Organization recommends a C-section rate between 10% and 15% (2,3)
  • C-section rates vary widely across high-income countries, from a low of 10% to a high of 37%, but there is no benefit to maternal or infant health with greater C-section rates (6).  On the contrary, among countries with already low mortality rates, maternal and infant deaths tend to increase with higher C-section rates (7). In other words, having a 15% C-section rate would be as safe (or safer) as having the current 30% BC rate.  This means that at least half of all C-sections performed in BC are unnecessary.
  • Only about a third of C-sections in BC are scheduled (planned).  The other two thirds are unplanned, emergency C-sections (1).  This means that the vast majority of C-sections are performed despite the fact that the mother planned for a normal vaginal birth.  Only 2% (1 out of 50) of C-sections in BC are done because the mothers requested them (8).
  • The type of primary health care provider a woman chooses for her pregnancy and birth can have a huge effect on her risk for C-section. Women who have an obstetrician as their primary health care provider have a 46% C-section rate; those who choose a family physician have a 22% C-section rate, and those who choose a midwife have only a 15% C-section rate (5).

    Forceps and vacuum extraction

    • 17% of first-time mothers in BC have instrumental vaginal delivery with forceps or vacuum (1)
    • During forceps and vacuum extraction, the baby's head is forcefully pulled through the birth canal faster than it would naturally emerge (9), causing more vaginal and possibly rectal tearing to the mother than would naturally occur.
    • 31% of women who undergo forceps delivery will have vaginal tearing that extends to include rectal damage (third- or fourth-degree tear); 17% of women who deliver by vacuum extraction have such severe tears, and only 5% of women who deliver without the use of forceps or vacuum will have such tears (10).
    • Forceps causes significantly more maternal trauma than vacuum (10,11).  Yet, in some large hospitals such as BC Women's Hospital in Vancouver, forceps is still used more frequently than vacuum (1).
    • The incidence of vaginal and/or rectal tearing during birth (1st, 2nd, 3rd or 4th degree) can vary from as low as 50% to as high as 90% across hospitals.  The more babies a hospital delivers, the greater the risk of vaginal and rectal tearing to the mother (12).


    References

    1. BC Perinatal Health Program, Perinatal Health Report 2008. Published in 2010.

    2. World Health Organization. Appropriate technology for birth. Lancet, 1985: 2: p. 436-7.

    3. Wagner, M. (1994). Pursuing the birth machine; the search for appropriate birth technology. Camperdown: ACE Graphics.

    4. Kitzinger, S., Birth Crisis. 2006, New York, NY: Routledge.

    5. BC Perinatal Health Program. Caesarean Birth Task Force Report 2008. Vancouver, BC. Februrary 2008.

    6. Althabe, F., et al., Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study. Birth, 2006. 33 (4): p. 270-7.

    7. Betran, A.P., et al., Rates of caesarean section: analysis of global, regional and national estimates. Paediatric and Perinatal Epidemiology, 2007. 21(2): p. 98-113

    8. Hanley, G.E., P.A. Janssen, and D. Greyson, Regional variation in the cesarean delivery and assisted vaginal delivery rates.Obstetrics and gynecology, 2010.115(6): p. 1201-8.

    9. Cunningham, F.G., et al., Williams Obstetrics. 23rd ed. 2010, New York, NY: The McGraw-Hill Companies. Inc.

    10. Wen, S., et al., Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries. American Journal of Epidemiology, 2001. 153(2): p. 103–7.

    11. Johanson, R. & Menon, V. Vacuum extraction versus forceps for assisted vaginal delivery. The Cochrane Library: prenancy and childbirth database. 2010.

    12. Baghurst, P. A. The trouble with clinical indicators: Intact lower genital tract following childbirth in NSW Hospitals, 2003-2005. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 2010. 50, p.45-50.


    Artwork:  
    "Self-portrait at the end of the day" Copyright © 2007 Amanda Greavettehttp://www.amandagreavette.com