Today, as Cesarean Awareness Month continues, the Canadian Institute for Health Information (CIHI) released data examining the number of babies born by cesarean in Canada. Cesarean surgery is the most common inpatient surgical procedure in Canada, similar to the United States. 28.2% of all Canadian births were cesarean births in 2016-2017. For comparison, the USA's cesarean rate is 31.9%. While the USA's rate is creeping down ever so slowly, the Canadian cesarean rate in the most recent year is up from the year before.

Interestingly, the cesarean rate amongst Canada's provinces and territories has a large variation. British Columbia, the most western province has the highest rate of cesarean births at 35.3%. Within the BC province, Metro Vancouver's Fraser Health region, at close to 40%. The Northwest Territories has the lowest rate at 18.5%. The Northwest Territories is a vast and sparsely populated place, and there are limited services available for anything but healthy low-risk births. Higher risk parents are flown out to a tertiary care facility to receive maternity care services.

Maternal-infant health researchers are concerned about the rising cesarean rate and the variations between provinces. Additionally, there are questions about what is creating the variations between facilities within a single province. Prevention of the primary cesarean plays a critical role in reducing further complications when subsequent pregnancies occur. In general, the overall state of maternity care, including maternal mortality and morbidity, preterm births and other indicators demonstrate that Canada is doing much better than her neighbor to the south, the USA, on all accounts. Midwifery care is an integrated option for consumers in Canada and registered midwives can follow their clients to the hospital for continuity of care if a transfer is needed for a planned out of hospital birth.

As the cesarean rate has increased, the number of babies born by either vacuum or forceps has also been declining. 13.0% of all Canadian babies were born with the assistance of vacuum or forceps in 2016-17. The rate has been declining for at least the past 10 years. A very useful "QuickStats" tool is available for digging deeper into different birth statistics (and other non-maternity health stats as well) broken down by province in Canada. I encourage you to poke around and play with the data and compare and contrast the differences amongst various indicators. No one is pleased with the current cesarean birth rate and a deeper examination is required to determine what is driving it and how the number of babies delivered by cesarean can be reduced.

Chart source: Canadian Institute for Health Information

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