Thursday, April 27, 2006


Too posh to push?

There is an interesting article in the Ottawa Citizen this morning that talks about how the rates of birth via caesarean section are rising, and how the added cost is straining the medical system. (But, I can't help but ask, will the medical system be dealing with hemorrhoids for years after all that straining?)

According to a report released by the Canadian Institute for Health Information called Giving Birth in Canada: The Costs, the rate of births by c-section have climbed to 24%, as compared to just 17% in the early 1990s.

The cost of a birth by c-section averages $4,600, while a vaginal delivery costs $2,800. (This, of course, is cost to the 'system'. It is one of the miracles of medicare that I walked out of the hospital after each of my sons' births paying only the $200/night upgrade from a ward room to a private room, and even that was reimbursed at 50% by my supplementary medical coverage.)

The Citizen article says that in some Canadian cities, caesarean rates are approaching 30% of all births, almost twice as high as considered medically necessary by the World Health Organization.

What I want to know is how people are getting these 'convenience c-sections'? Although I'm well-acquainted with the idea through the countless hours I spent on fertility and pregnancy message boards when I was carrying Tristan and Simon, I truly thought they were an American phenomenon.

When I was endlessly pregnant with Simon, as he moved off the large-fetus charts and onto the 'you are gestating an elephant-calf' charts, I begged for an induction - just an induction, mind you, at a week after my due date - and they wouldn't hear of it.

Personally, I don't get why anyone would choose a c-section over a vaginal birth. In fact, when my labour with Simon stalled somewhere around the 20th time in the 20th hour of labour and the spectre of a c-section began to materialize, I was terrified. To me, a c-section would have been a bit of a disappointment. There is an undeniable sense of empowerment, and a celebration of your body's capabilities, that comes with pushing that baby out. (She said, in the hazy afterglow of two years past.)

I also can't imagine having to deal with healing from surgical incisions in addition to dealing with everything else that came with caring for a newborn. The sleep deprivation and the cracked and blistered nipples alone nearly put me over the edge; the idea of trying to cope with incisions and whatnot, and of not being able to pick up my then two-year-old eldest son for weeks, is almost unimaginable.

Don't get me wrong, I am absolutely not criticizing caesarean births. Heck, that's how I got here. (Breech baby, stubborn from the womb.) But it really does surprise me that (a) someone who is otherwise healthy and capable of delivering vaginally would choose a c-section, and (b) that an obstetrican would allow it, especially given the cost is 60% higher - let alone the additional health risks and longer recovery times associated with c-sections.

It's all very interesting! What do you think? First, I'm curious as to whether the costs in Canada are similar to those in other countries. What do you think about elective c-sections? Would you? Did you? And since we as taxpayers are footing the bill, so to speak, should obstetricians permit medically unnecessary c-sections?