Tuesday, January 24, 2012

Vaginal Birth Roulette (Part 1): Data from the British Columbia Vital Statistics Agency 2009 Annual Report

I have spent a good chunk of my career immersed in Vital Statistics, for several years I was part of the team that published the BC Vital Statistics Agency's Annual Report. As a result, any assumptions I may have had about birth being a natural process that generally goes well for the vast majority of women - were shattered long before my first pregnancy. Birth is an uncertain event, both for the mother and for her child. There's a lot that can and does go wrong. I'm certain my background with this information played a role in my seeking out a c-section the first time around - as one of my primary motivators (then) was a reduction in the level of uncertainty and elimination of the more extreme risks of childbirth. For myself, the trade that eliminated of the risks of natural childbirth in exchange for the risks of surgical birth was worth making. I quite simply was not willing to play "Planned Vaginal Birth Roulette".

According to the 2009 BC Vital Statistics Agency's Annual Report (the most recent report available), women aged 30 to 39 had 22,742 live births in 2009. Among these live births:

More than 1 in 2 live births (56.1 percent) had 1 or more maternal complications, for example:

1 in 18 had an obstructed labour (5.6 percent)
1 in 22 had evidence of fetal distress (4.5 percent)
1 in 98 had cord complications (1.2 percent)
1 in 7 had an assisted or surgical delivery - no cause given (14.6 percent)
1 in 7 had an abnormality of pelvic organs (14.2 percent)

Furthermore 1 in 3 live births had perinatal conditions, for example:
1 in 6 had intrauterine hypoxia and birth asphyxia (16.7 percent)
1 in 58 had complications of the placenta, cord and membranes (1.7 percent)
1 in 11 were affected by disorders related to long gestations or high birth weights (9.1 percent)
1 in 842 were affected by perinatal birth trauma (0.012 percent)

In 2009, among women aged 30 to 39, only 55.6 percent (slightly more than 1 in 2) live births in British Columbia were "Spontaneous Vertex" deliveries, more than 1 in 3 (34.3 percent) were ceserean sections (either first or repeat c-sections) and the remainder were vacuum or forceps assisted vaginal deliveries (9.7 percent) or spontaneous breech (0.3 percent).

From this information it is clear that giving birth in British Columbia is anything but a "sure thing" and certainly is not "as safe as life gets".


  1. 1 in 6 had intrauterine hypoxia and birth asphyxia (16.7 percent)??!!

    Jeez, if that is not an indication that perhaps more c-sections should be done, I don't know what is!! That is SHOCKING. Wonder what the long-term costs are? And I'm sure that with these sorts of numbers, there are costs.

    As well, do you know what the comparable numbers are in other provinces?

    1. Don't know what the comparable numbers are for other provinces, and I don't know what share of intrauterine hypoxia/birth asphyxia results in clinically significant deficits. The data from the BC Perinatal Health Program is even more eye opening and will be explored in a subsequent post.