COSTLY
CAESAREANS: 2005 NDP PUBLIC HEARINGS
February 26, 2005
Edmonton , Alberta , Canada
Alarming Trend Towards Increase
of C-Section Section Rates
Economic Consequences, and Possible Solutions the Government of Alberta Should
Not Ignore –
Claudia Villeneuve, Civil
Engineer, Doula, and Childbirth Instructor
Edmonton VBAC Support Association/ICAN of Edmonton
Thank you to the distinguished
members of the panel: NDP MLA Mr. Raj Pannu, NDP
MLA Mr. Ray Martin, and Community representative and activist,
Ms. Sheila Barg for this amazing opportunity.
My name is Claudia Villeneuve,
I am a volunteer with the Edmonton VBAC Support Association
(ICAN of Edmonton ). We are a non-profit organization that
seeks to support women and their families who wish to avoid
c-sections.
The purpose of this NDP public hearing
was to gather the public's opinion regarding our Government's
plan to innovate health care by expanding private care and
by increasing user fees, on the claim that medicare is un-sustainable.
My presentation today will address these
two items in the NDP agenda “Cost and Sustainability” of
the health care system.
- I think sustainability refers to our ability
to maintain our public health system operating on public
funds, and our ability to maintain the health of our population.
- C-sections are on the most common surgeries being done
today, and the fact is that the great majority of them
are medically unnecessary or easily avoidable. C-sections
carry serious health risks to otherwise healthy mothers
and babies, and cost our health care system millions of
dollars a year. We must reduce our c-section rate.
- I am an example of putting the items on this agenda into
action. I myself avoided a second unnecessary c-section
by having a homebirth with a midwife. Unfortunately the
province did not pay for the midwife, I did that out-of-pocket.
In contrast, an elective c-section would've been free.
There is an alarming trend towards increase of c-section rates in Alberta :
- The current c-section rate in Alberta is close to 23%.
This rate has been steadily increasing and it has no signs
of ever stopping or of ever being reduced. Let's be clear:
An increase in c-sections does not equal an improvement
in birth outcomes for women and their babies. I give you
this quote:
The Cesarean section rate in
the U.S. rose from 5% in 1970 to 23.6% in 1992.
This increase was not accompanied by any related
improvements in infant morbidity or mortality.
In other words, while more and more Cesareans are
being performed, it is not making women or babies
healthier. (Source: Unnecessary Cesarean Sections:
Curing a National Epidemic - Public Citizens' Health
Research Group, May 1994. by Sidney M. Wolfe, MD.
at www.citizen.org )
-
In Alberta today, women are being forced into caesareans
they do not want.
- Women with unusual pregnancies such as being obese
or being over 35 years of age, are recommended c-sections
as a matter of course.
- Women with previous c-sections are routinely advised,
and sometimes pressured, to always give birth by
c-section.
- Women are refused, by some hospitals and caregivers,
the opportunity to have attempt a VBAC or vaginal
birth after c-section, giving them little choice
but to schedule a c-section or give birth somewhere
else.
- Women with breech babies are now told is mandatory
to have a c-section if the baby does not turn head
down. The mandatory part of it is not true, as women
should always have the power to choose how to give
birth.
- Blanket policies on breech c-sections and bans
on VBAC are bad policies, and one-size-fits-all medicine
is bad medicine.
Ever wonder what the economic consequences
of a continuous increase in c-section rates in Alberta
are?
- The economic consequences of increased c-section
rates are catastrophic:
- While physiological vaginal birth costs the Alberta
Government about $2,500, every c-section is about $5,000
- $10,000 if not much more. This is an increase of twice
to quadruple the cost.
- The costs of c-sections include initial hospitalization,
surgical team time, drugs and medical supplies, administration
costs, post-recovery, re-hospitalization; and of course,
the mandatory or elective repeat c-sections in the future.
- In Alberta , we are certainly well on our way to swallowing
our health care budget paying for unnecessary and perfectly
avoidable c-sections and adding very serious risks to the
health of women and babies. I give you this quote:
A major Harvard Research Group Study in 1987 contends that
about half of the nearly 500,000 c-sections performed in the United States
are unnecessary, wasting well over $1 billion a year (Source: Citizen
Action and Other Big Ideas, A History of Ralph Nader and the
Modern Consumer Movement, by David Bollier, Chapter 7 - The Politics
of Health, at www.nader.org).
For the sake of our health care
budget can we reduce the c-section rate? Yes, we can.
• Giving birth is a natural
process, like breathing and eating.
“About 95% of births are un-eventful
when un-interrupted”, is a quote attached to Ina May Gaskin,
a world-renowned midwife and midwife trainer.
• But in our standard of care
in Alberta , we interrupt pregnancies and births all the
time, therefore complicating their outcome and risking the
welfare of women and their babies.
These are possible solutions in
reducing the c-section rate that the Government of Alberta
should not ignore:
- Remove the financial and legal incentives to do c-sections
by paying the same for every birth, and protecting caregivers
from frivolous lawsuits. Defensive medicine should not
be tolerated. A conflict of interest should not be allowed
to form.
- Remove the mandatory c-section policies that exist for
breech babies, and other contraindications. One
size fits all medicine, is bad medicine. Remove
the blanket ban on VBAC, vaginal birth after c-section.
Women should have the right to choose how to give birth.
- Fund midwifery care through the medicare system,
as ALL of the other major provinces in Canada have already
done. It is critical to allow Albertan women
free access to midwives anywhere in the province. Alberta
doesn't cover the $2,500 cost to have a midwife birth
at home, but it continues to fund more expensive and
risky elective c-sections in hospital.
- About 75% of midwifery clients never even enter the hospital
saving the health care system hundreds of thousands of
dollars every year in hospitalization, epidurals and c-sections
that never happened.
- It is also critical that we allow midwives the freedom
to practice using ideals of midwifery meaning that there
will be no barriers to the type of vaginal births they
can attend (for example: VBAC and homebirths). The ideals
of midwifery respect women's bodies, women's choices, and
the natural process of birth. That is why midwives are
the key factor to reducing the c-section rate in Alberta
, and of helping us balance and sustain the health care
budget.
Conclusion
The purpose of this NDP hearing was to
gather the public's opinion regarding our Government's plan
to innovate health care by expanding private care and by
increasing user fees, on the claim that medicare is un-sustainable.
• Following the current trend
of making c-sections the standard of care when giving birth,
yes, and that could make the claim of un-sustainability correct
.
What makes the Alberta health system
very un-sustainable in terms of healthy outcomes, and balanced
budgets?
• Routine use of medical interventions
that are known to lead to c-sections
• Mandatory c-section policies,
such as with breech birth
• Automatic repeat c-sections
• Refusal by certain hospitals
and caregivers to allow women the opportunity to have a VBAC
or vaginal birth after c-section
• And the steadfast refusal
of this Alberta Government to fund midwifery at home or at
hospital. Alberta is the last major Canadian province to
have un-funded midwifery.
• The c-section rate is increasing,
and with that our costs to the health care system. I leave
you with this quote:
Canada 's caesarean section rate reached
an all-time high of 22.5% of in-hospital deliveries in
2001–2002, according to a new report by the Canadian
Institute for Health Information CIHI. This trend
coincides with a decline in the number of family doctors
providing full maternity care (Source: More
Than 1 in 5 Canadian Babies Now Delivered by C-Section,
CIHI press release, April 21, 2004, at at www.secure.cihi.ca ).
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