Monday, January 30, 2012

Vaginal Birth Roulette (Part 2): Data From the BC Perinatal Services 2007/08

Another source of information on birth in BC is the Perinatal Services Annual Report. The most recent report is for fiscal 2007/08. According to this report, among women giving birth for the first time, fewer than 1 in 2 (49.7 percent) had a spontaneous vaginal delivery, fewer than 1 in 2 (47.5 percent) had epidural anesthesia and more than 1 in 6 (17.3 percent) had an instrument assisted delivery. More than 1 in 3 first time mothers (33 percent) delivered by caesarean.

It is interesting to note that of the 53.2 percent of women considered "normal" at the onset of labour (spontaneous onset of labour, singleton in vertex presentation, no previous caesarean, term gestation of 37-42 weeks), 3 in 4 had a "spontaneous vaginal delivery", with 12.4 percent having an assisted vaginal delivery and 11.3 percent having a cesarean section. Among nulliparous moms meeting this criteria 60.2 percent had a "spontaneous vaginal delivery", while nearly 1 in 5 had either an assisted vaginal delivery or a caesearean section. Among women who have previously given birth meeting the definition of "normal" at the onset of labour, nearly 93 percent go on to have "spontaneous vaginal delivery" while 1 in 20 (4.8 percent) have assisted vaginal deliveries and about 1 in 39 (2.6 percent) have caesarean sections.

Only 38 percent (neraly 2 out of 5) of all caesesareans in British Columbia in 2007/08 were elective caesareans (and of that the vast majority of these had a 'medical indication'). The BC perinatal services annual report lumps in maternal request with VBAC declined indicates that 4.1 percent of births fall into this categoy. Assuming all of those are planned c-sections 543 maternal request/VBAC declined caesareans were undertaken in 2007/08 - accounting for 10.5 percent of all elective caesareans. I note that the vast majority of these are likely to be VBACs that were declined - and I personally would not consider declining a VBAC to be a "maternal request c-section". Sixty-two percent (more than 3 out of 5) of all caesareans in BC in 2007/07 were urgent or emergent.

As a percentage of all vaginal deliveries - the risk of a 3rd or 4th degree laceration was 4 percent. Episiotomies happend in 9 percent of cases. Slightly less than half of all vaginal births in first-time moms involved use of an epidural and around 30 percent of all vaginal births involved use of an epidural. As stated in a previous blog post - there is a large discrepancy in epidural use in BC compared to other provinces - which suggests to me that there may be some issues related to accessing this form of pain relief in BC.

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