Should Elective Cesarean Births Be Covered By Provincial Health Plans? – Birth Takes a Village

The big news in the Canadian birth world this week was an article that announced Ontario is considering cutting coverage for medically unnecessary cesarean births.

On the surface, this makes total sense to me. Having an elective cesarean birth is akin to having elective surgery of any kind, and therefore it seems reasonable  for it not to be covered by provincial health plans. If we spend less money on medically unnecessary cesarean births and put that money into training more midwives and educating women about birth in a way that is supportive and positive, we might have a more cost-effective system with better birth outcomes.

However, we have created a culture where many women (and doctors!) are often scared of vaginal birth. This culture is the product of years of promoting over-medicalized birth, portraying birth as scary and painful in the media and avoiding bringing up our children with an awareness of the real process of childbirth.

The birth culture we have created is what has led to our unnecessarily high rate of cesarean births. This includes, but is not limited to, elective cesareans. If we want to reduce the cesarean rate, we need to shift our birth culture to one that promotes and supports vaginal birth, one that teaches women vaginal births are safe and provides them access to resources for having healthy vaginal births. I worry that taking away their option for cesarean births without working on our birth culture may be dangerous and unfair.

According to a counsellor who used to work for the Elective Cesarean Clinic at the Best Birth Clinic, one of the most common reasons  given for elective cesareans is having had a previously traumatic birth.

If my interactions with women who have experienced trauma during labour and birth has taught me anything, it’s that we need to give these women back their power. Why do they choose elective cesareans? Partially out of fear they will have a repeated traumatic experience, partially as a way to get control in a medical system that they feel previously let them down.

Telling these women they cannot have an elective cesarean because physically there is no medical reason to do so takes away even more of their power. Although I believe having a vaginal birth after a previously traumatic birth has the potential to be a healing experience in many circumstances with the right support and care, I think most importantly women need to feel in control of their bodies and what happens to them. 

Would women who desire elective cesareans for phsycological or emotional reasons be provided with coverage for these surgeries? Would they be provided with resources to help them cope with their previous experiences around birth and support them through a healthy and positive vaginal birth?

I absolutely agree with the article when it says “Women who give birth by C-section spend more time in hospital, often a few days, adding to costs in the health-care system. Some women opt to give birth at home with midwives, which further saves the system money and reduces the risk of mothers and babies contracting hospital-based infections.” Vaginal births are also often considered more ideal for breastfeeding success and postpartum recovery.

I do think we need to work on reducing the cesarean birth rate in Canada. Numbers for “elective” and “emergency” cesarean births are both way too high. I believe the solution mostly lies in educating doctors and the general population that birth is not a medical procedure which is inherently dangerous or leads to suffering. We need to shift our birth culture to one which provides women access to positive and accurate information about birth, so they can plan to have vaginal births with a trust in their bodies’ ability to do so.

I talk about Power to Push so much in my blog, you’d think they were paying me! But I can’t HELP mentioning them again here. The Power to Push Campaign and Best Birth Clinic at BC Women’s Hospital here in Vancouver has undertaken the goal of reducing the cesarean birth rate in BC. They are doing an amazing job of supporting vaginal births for women who would normally end up on the path to a c-section, such as women who have had previous cesareans or who’s babies are in a breech position. Their elective cesarean clinic has counsellors on staff. Their goal is to help women “push for the best birth possible.” If we really want to reduce cesarean births in Canada, we need more campaigns like this, more midwives, more access to information and support for healthy vaginal births. We need to shift the culture we have around birth to start creating real change.

You can read more about my perspectives on birth culture in the birth culture and philosophy categories on my blog. You may also want to read an article I posted earlier this week, Promoting A Gentle And Informed Birth Culture.

For more information on Cesarean Birth here in B.C., visit OptimalBirth BC.

Here are a few of things I think require some thought when considering cutting coverage for elective cesarean births:

• Define medically unnecessary. Should women who have psychological and emotional reasons for desiring cesareans be in this category? If they are not going to plan a cesarean, should they be provided with other resources to help them cope well with a vaginal birth?

• Would some of the financial resources for elective cesareans be redirected to increase access to midwifery care , prenatal education, and campaigns promoting vaginal birth with accurate and supportive information?

• Is cutting funding for elective cesareans the first step in sending the message that vaginal birth is safe and generally preferrable? Or are there other steps that should be taken before we should consider cutting funding?

I agree whole-heartedly that fewer cesarean births are generally best for our women, newborns and our healthcare system. But the methods we use to achieve that goal need to be well thought out and considerate of the state of our current culture around birth.

Comments welcome below. If you have any information, research or thoughts on this subject, I’d love to hear from you!