A new study by University of British Columbia researchers has found that fewer than 2% of cesarean births in BC were a result of maternal request, and that the number of cesarean and assisted vaginal deliveries varied widely across health regions in BC over a 4-year period.

Published in the June issue of Obstetrics & Gynecology, the UBC study examined all deliveries in BC between 2004 and 2007 and found an average of 21.2 per 100 deliveries were first-time C-sections, and 14.2 per 100 deliveries were assisted vaginal deliveries involving the use of forceps or vacuum devices, or both. 

Dystocia was the most common reason for cesarean deliveries (30%), followed by non-reassuring fetal heart rate (19.1%).

Canada’s cesarean delivery rate has increased dramatically over the past two decades, reaching a high of 26.3% of in-hospital deliveries in 2005–2006. Until recently, BC had the highest cesarean rate in the country, according to the Canadian Institute for Health Information.

The study also found significant regional variations in cesarean and assisted vaginal delivery rates across BC’s 16 health services delivery areas that could not be explained by ac­counting for medical indications for these procedures. 

Cesarean delivery rates ranged from 27.5% in the South Vancouver Island area to 16.1% in Kootenay Boundary. Assisted vaginal delivery rates ranged from 18.6% in Vancouver to 8.6% in East Kootenay.

According to study researchers, those variations reveal a need to further investigate the reason behind these large differences within the province’s system.

The researchers suggest potential reasons may include the differences in practitioners’ responses to similar medical situations, such as dystocia, including how they interpret and res­pond to the condition, and how they factor the resources available to them into their decisions. 

Co-authors of the study include Patricia Janssen, Associate Professor at the School of Population and Public Health, and Devon Greyson, data specialist at the Centre for Health Services and Policy Research.