Declining cesarean section rates: a continuing trend?

Since the mid-1980s, cesarean section rates in Canada have declined. By 1993, 18 of every 100 deliveries were by cesarean section, compared with close to 20 per 100 in 1987. As well, in 1993, 9 of every 100 deliveries were primary cesareans, down from a high of almost 11 per 100 in the mid-1980s. And the repeat cesarean section rate fell from 39 per 100 cesareans in the mid-1980s to 34 in 1993. A major factor in the downtum of cesarean section rates has been a steady increase in vaginal births after cesarean section (VBACs). From 1979 to 1993, the rate rose more than tenfold from 3 to 33 per 100 women who previously had a cesarean section. This trend toward VBAC deliveries was apparent among women in all age groups. Within Canada, there are large provincial differences in cesarean section and VBAC rates. In 1993, cesarean rates ranged from 15 per 100 deliveries in Manitoba to 22 in New Brunswick. VBAC rates ranged from 16 per 100 previous cesarean sections in New Brunswick and Newfoundland to 42 in Alberta. This article traces trends in cesarean section and VBAC rates in Canada and the provinces from 1979 to 1993. The data are based on individual patient admission/separation records of general and allied hospitals, that are submitted to Statistics Canada.