Grant: Project Grant

Cesarean delivery (C-section) is a surgery used to deliver a baby through incisions made to the abdomen and uterus. Although in some situations it can be a life-saving surgery for a pregnant individual or their newborn, it is increasingly being performed in situations when it is not medically necessary. This is a concern, because the decision to perform a Cesarean has consequences for health that extend well beyond the time of delivery, affecting post-partum recovery, future pregnancies, and longer-term bladder control. In a publicly funded health care system such as Canada's, the cost of performing a Cesarean delivery when it is not medically necessary is a key consideration in developing policies guiding its use. However, we have a very poor understanding of what the full cost implications are of conducting a Cesarean delivery with no medical indication in Canada. Available cost estimates are usually limited to those incurred during the hospital stay for the delivery, and don't include the costs of caring for longer-term consequences. Further, available cost estimates mix together the costs of Cesareans that have a clear medical indication with those that do not. In this project, we will use existing medical records from deliveries in British Columbia, Canada, linked with subsequent health visits and hospital stays to determine the broader, longer-term cost implications of performing a Cesarean delivery when it is not medically necessary. We will identify two different situations in which these Cesareans are performed: planned C-sections done before labour starts (often called 'maternal request'), and C-sections done too early during labour. We will identify the costs to the health care system of these deliveries, and compare them to those in which a vaginal birth was attempted. Our findings will provide policy-makers and obstetrical leaders with a key piece of information needed to develop sound policies on the use of Cesarean delivery in Canada.