Cape Breton Regional Hospital has highest C-section rate for low-risk mothers in N.S.

Cape Breton Regional Hospital is seeing a rise in caesarean sections among mothers with low-risk pregnancies. 

About 23 per cent of women with a low-risk pregnancy who gave birth at the hospital between 2017 and 2020 had C-sections, according to numbers from the Reproductive Care Program of Nova Scotia. 

The rate in the province overall climbed from 13 per cent in 2016 to 17 per cent in 2020, according to data from the Canadian Institute for Health Information.

Nova Scotia's health authority is taking a look at those numbers. 

"We have been looking at C-section rates for so many years now and, in fact, it's one of our key performance indicators," said Sally Lorring, senior director for women and children's health for the health authority.

"But we haven't actually focused specifically on low-risk. We've been looking at other aspects of a C-section because obviously we would be for everybody to deliver vaginally rather than needing to go for a C-section."

Low-risk generally means it's a person's first pregnancy, the baby is full-term and in the correct position, the mother hasn't been induced, and it's a single pregnancy, meaning no twins or other multiples. The definition excludes many pre-existing or pregnancy-related conditions.

Looking into why

It's unclear why the rate is going up, but quality-control committees at hospitals can play a role in identifying the causes. Hospital staff can look at decision-making and what is actually happening in delivery rooms. 

"How did they interpret the fetal heart-rate tracing," said Dr. Heather Scott, an obstetrician and the reproductive care program's outgoing obstetrical medical adviser.

"Were they doing regular pelvic examinations and, therefore, diagnosing what we call dystocia in labour, was that an accurate diagnosis? So you need to try to understand some of the decision-making."

Lorring said obstetricians at the Cape Breton Regional Hospital are aware of the latest numbers.

Minimizing the use of C-sections

Dr. Margaret Morris, president-elect of the Society of Obstetricians and Gynaecologists of Canada, has been advocating for lowering all C-section rates across Canada.

"We do want to minimize the caesarean section rate for all of the obvious reasons: the maternal impact, the maternal morbidity and mortality is higher for the mom," said Morris. 

"When you do a caesarean section? It can vary from very minor complications to major complications."

Although the procedure can be life-saving for both mother and baby, it does come with a greater risk of hemorrhage, infection and other complications.

C-sections also use hospital resources like operating rooms, nurses and anesthesiologists.

Morris said one thing that could help prevent some low-risk C-sections would be to allow women to labour longer in the latent, or early, stage of labour. 

"Understanding that the latent stage of labour can last longer than was previously identified so that might help the women who are first-time moms coming into labour," said Morris.

Morris pointed to midwifery as a model of care that could help promote that idea, as midwives generally allow women to labour longer in the latent stage already.

In Nova Scotia, there are midwives based in Fishermen's Memorial Hospital in Lunenburg, the IWK in Halifax and at St. Martha's in Antigonish. However, there aren't any midwives practising at Cape Breton Regional Hospital.

Continuity of care

CJ Blennerhassett, the president of the Midwives Association of Nova Scotia, said having continuity of care can be a big help in preventing an unnecessary C-section.

"Having access to a nurse, a doula, a midwife, somebody who is going to be with you throughout the entirety of the labour and delivery process and acts as your navigator through that process … that improves outcomes," said Blennerhassett.

"We have really good research from across the world to show that one to one supportive care in labour and birth results in less caesarean sections."

According to the health authority, Cape Breton Regional has a full complement of obstetricians and, although there are some nursing vacancies, casual positions have been able to fill the gaps. 

Blennerhassett said spending time one on one with patients before and during labour can also help keep them informed of what's going on and help them make decisions if they choose to get pregnant again.

"I think education is one of the most important things we do as a health-care provider in pregnancy."