On January 18, 2021, an article was published in The Ottawa Citizen that concerned me, especially in the context of recent progress by the Society of Obstetricians and Gynecologists of Canada (SOGC) on caesarean birth choice.

Titled Morris and Carson: It’s time to curb rising C-section rates in Canada, it set out the views of Dr. Margaret Morris, president-designate of the SOGC, and Dr. George Carson, past president of the SOGC.

This is the (unpublished) letter I wrote to the Editor, on January 22:

Reducing caesarean birth rates is a narrow-sighted and often value-laden target, and this push for provincial homogeneity could have unintended consequences. What matters most is information, consent and support for both place and mode of birth plans, and focusing on outcomes rather than processes. Particularly, stillbirth, perinatal mortality, birth injuries, and maternal satisfaction. Last year, a Fraser Institute report comparing healthcare performance indicators in OECD countries found Canada ranks last for obstetric trauma during vaginal birth (19th out of 19), with and without instruments. For perinatal mortality, it ranks 22nd (out of 28); compared with 7th (out of 19) for post-operative wound dehiscence, and 2nd (out of 18) for abdominal surgery post-operative sepsis.

In the UK, there is currently a government inquiry into maternity safety, unprecedented levels of litigation claims, and criminal investigations underway in hospitals once praised for achieving comparatively low caesarean rates, and using limited healthcare resources wisely. The problem is, they meticulously tallied, investigated and reported caesarean births, while denying requests, and ignoring intrapartum deaths and pelvic floor injuries. While I do not believe any of this is the intention here, I would counter, with the greatest respect, that it’s past time to curb focusing on caesarean rates, anywhere.