Preventable obstetrical interventions: how many caesarean sections can be prevented in Canada?

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Services Research

Background:

• Rising Caesarean section (CS) rates in Canada, nearing one in three births, raise public health concerns.
• A significant proportion of these CS may be preventable, particularly in low-risk pregnancies.

Purpose of the Study:

• To identify preventable obstetrical interventions contributing to high CS rates.
• To propose an analytical framework for reducing CS rates in low-risk pregnancies.

Main Methods:

• Analysis of CS rate variations (1969-2009) using the Quebec hospitalization database (MED-ÉCHO).
• Extraction of data from a systematic review on obstetrical interventions to calculate population-attributable fractions for CS.
• Identification of strategies associated with reduced CS probability.

Main Results:

• Expectant management and planned vaginal birth after CS are leading strategies for CS reduction.
• Increasing vaginal birth after CS to 1995 levels could lower the current rate from 23.2% to 21.0%.
• Other effective strategies include non-pharmacological pain management, intermittent fetal heart auscultation, and quality audits.

Conclusions:

• Empirical evidence supports the concept of preventable Caesarean sections.
• Realistic strategies exist to potentially maintain CS rates near 20% in Quebec.