MedicalResearch.com Interview with:
Giulia Muraca, PhD, MPH
School of Population and Public Health
BC Children’s Hospital Research Institute
Faculty of Medicine
University of British Columbia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: While cesarean delivery rates have increased in Canada over the last few decades, as in most industrialized settings, the rate of forceps and vacuum deliveries have declined. These opposing trends have led to recommendations to increase forceps and vacuum delivery rates as a strategy to reduce cesarean delivery rates.
We found that the rate of obstetric trauma in Canada increased significantly in recent years, especially among forceps deliveries. In first-time mothers, the rate of obstetric trauma increased by 7% among forceps deliveries (from 19.4% in 2004 to 26.5% in 2014) and in women who had a previous cesarean delivery, the rate of obstetric trauma among forceps deliveries increased by 9% (from 16.6% to 25.6%).
We found that a 1% increase in the forceps and vacuum delivery rate in Canada was associated with approximately 700 additional cases of obstetric trauma and 18 additional cases of severe birth trauma annually among first-time mothers alone.
MedicalResearch.com: What should readers take away from your report?
Response: Our results suggest that encouraging higher rates of forceps and vacuum delivery as a strategy to reduce the cesarean delivery rate could result in substantial increases in obstetric trauma and severe birth trauma.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further research is required to shed light on the reasons for the high rates of obstetric trauma in Canada among women with an operative vaginal delivery, the implications for affected women and the healthcare system, both acute and long-term, and the burden attributable to operative vaginal delivery.
MedicalResearch.com: Is there anything else you would like to add?
Response: There is no doubt that concerns relating to the increasing rate of cesarean delivery are reasonable. The risks associated with cesarean delivery, such as infection or hemorrhage, and uterine rupture or morbid placentation in subsequent pregnancies, have been well characterized. However, it is not reasonable to advocate for a reduction in the cesarean delivery rate without evaluating the maternal and perinatal outcomes associated with this reduction. Neglecting to do so would mean that the rate of cesarean delivery is the performance indicator of obstetric service quality rather than maternal and perinatal safety. And that just doesn’t make sense. It would be far more rational to focus on indices of perinatal and maternal severe morbidity and mortality that quantify safety and well-being of mothers and babies.
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