Provincially, the Cesarean rates in 1988-89 were highest in Newfoundland and British Columbia, and lowest in Manitoba. The C-section rate in Newfoundland was 50 percent greater than in Manitoba. Saskatchewan and Alberta also had lower rates than the other provinces.

A study in a small rural hospital in Alberta showed that by adopting the recommended 1985 guidelines, the C-Section rate was cut by almost 50 percent (CMAJ Dec\91).

Governments in British Columbia, Ontario and Nova Scotia have been calling on doctors to follow the guidelines more closely. The Ontario Cesarean Birth Planning Committee recommended that "labour after a previous Cesarean be the standard of care for women with no identifiable risk." The committee recommended that a healthy woman with a previous section with a transverse incision be placed in the low risk category on prenatal forms. The committee also recommended that doctors should attempt to turn a breech baby in to the head first position before birth, in order to prevent unnecessary Cesareans. Unfortunately, few doctors in North America are being trained in the art of safely delivering a breech baby through the vagina.

According to a 1989 U.S. study, (New England Journal of Medicine, Mar 16/89) chances of a C-section depends more on who a woman's doctor is than on any other single factor. In the study the C-section rate ranged from 19 to 42 percent according to the individual doctor's preferences.

Recent research by Dr. Michael Klein showed that the degree to which physicians interfere with the birthing process is a function of the setting of the delivery (hospital versus birthing center) and the belief system of the doctor. He believes that tendency to interfere with birth is drilled into doctors early on in their training. He found that doctors who had the highest rates of episiotomy, also had the highest rates of Cesarean sections. Dr. Klein commented that: "Not surprisingly, it turns out that a cutter is a cutter (Medical Post, Oct 13/92)." Find out before you deliver if your doctor has that tendency.

Getting More Support

Cesarean support groups and VBAC groups have sprung up throughout Canada and the U.S. to assist women in sorting out their feelings and to prevent future unnecessary Cesareans. By expressing their feelings to other women with the same experiences, women get a chance to release their feeling of loss, anger, sadness, and disappointment. For most women, the opportunity to have a normal birth after a Cesarean is an enormously gratifying and healing experience.

Dr. Ken Milne, Professor of Obstetrics at Western University in London, Ontario, and chairperson of the Ontario Cesarean Planning Committee, said at a Dec/92 conference in Toronto that VBAC is a philosophy, a different way of seeing the whole birth process. Dr. Milne suggested that hospitals publish their C-section rates, their forceps rates, and their rates of other interventions so that women can make informed choices.

The medical dictum, "Once a Cesarean, always a Cesarean, should be obsolete," said Dr. Milne, "In my opinion, every woman should be given the opportunity to deliver vaginally."

Doctors must educate their patients. Patients and self-help groups must educate their doctors. This joint effort will be the only way to put a halt to the unnecessary surgery being imposed on child-bearing women.

Resources:

BIRTH AFTER CESAREAN: THE MEDICAL FACTS, by Dr. Bruce Plamm (General 1992). Dr. Plamm is one of the leading experts on VBAC. He documents all the research, including the five year study he directed, on the safety of VBAC.

THE SILENT KNIFE: CESAREAN PREVENTION AND VAGINAL BIRTH AFTER CESAREAN, by Cohen and Estren, (1983). This book tells you how to avoid cesareans, how to heal after you have had one, and how to have a vaginal birth the next time around.

OPEN SEASON, A SURVIVAL GUIDE FOR NATURAL CHILDBIRTH AND VBAC IN THE 90'S, by Cohen (1991). This book urges child-bearing women to avoid unnecessary Cesareans and tells you exactly how.

BIRTH WITHOUT SURGERY (1988) A GUIDE TO PREVENTING UNNECESSARY CESAREANS, by Carl Jones is a step-by-step guide for a safer birth and avoiding unnecessary Cesareans using imagery and non-medical means.