Richmond Hospital is, in many ways, ground zero in the fight against a worrisome rising rate of C-section births across Canada.
New, national childbirth data released by the Canadian Institute for Health Information (CIHI) show a 5.6 per cent increase in C-section births over the past decade. The national average is now about 28 per cent but in B.C. it is roughly 35 per cent. At Richmond Hospital the rate is 30 per cent, which is one of the lowest among health regions in the province.
The hospital’s former head of obstetrics and long-time, Richmond-based OBGYN Dr. Brenda Wagner notes while C-sections serve a valuable purpose, some are unwarranted.
Prior to her 2001 arrival at the hospital, Richmond had the highest C-section rate in the province. That distinction has been flipped on its head.
“It was really a multi-disciplinary effort on the part of our leadership team. We had dedicated nurses, doctors, myself, who worked to start a culture of change and there have been a ton of people who have contributed along the way,” said Wagner, who now sits on the Perinatal Services B.C. Steering Committee.
The hospital has taken measures to make childbirth as natural and comfortable of a process as possible for women, said Wagner. Part of that may be a bit of tough love by not admitting women as soon as they may like — and sending them home to relax more.
When a woman is admitted too early Wagner said there is more intervention and this, it is thought, leads to the labour process going “off track,” leading to delays or complications.
“We have one of the best maternity teams and it is that that’s getting our numbers down,” said Wagner.
Wagner hypothesizes that the overall rise in C-sections is contributed to demographics but also an increased lack of knowledge of childbirth.
Over time “the population is changing, age changing, weight is changing. Then there’s the knowledge factor. Women don’t attend other people’s births. There isn’t as much a sharing of birth in the community, say as there was from 50 years ago,” said Wagner, noting television drama can skew perceptions as well.
So, “women now have different expectations,” she said.
Also on the rise, according to CIHI, is use of epidurals.
“With C-sections, moms think it’s an easy choice,” said Wagner.
However, C-sections increase a mother’s mortality rate (very low rate to begin with) and increase the risk of post-surgery complications and the need for hysterectomies.
“And we know there are good things for babies born vaginally,” such as a baby being exposed a special bacteria that lends to easier breast feeding.
Wagner said Richmond’s C-section rate for first-time moms is 15 per cent — “that’s good!”
However she questions if the overall rate can go down much further because many non-first-time moms are immigrants or foreigners, who have given birth outside of Canada where C-section rates are higher — particularly in China, the source of the vast majority (65 per cent) of new immigrants in Richmond, as well as the source of non-residents visiting to give birth.
“Because of the one-child policy, C-section rates were high,” said Wagner.
And about 70 per cent of moms who gave birth by C-section the first time, choose surgery again, said Wagner.
