The number of caesarean sections performed in Canada has reached an all-time high, with one in five babies delivered by C-section in 2001-2002, says a new report.

C-sections accounted for 22.5 per cent of all in-hospital deliveries during 2001-2002, a jump from 15 per cent of all deliveries in 1979-1980, reports the Canadian Institute for Health Information.

"We should be looking at it to see what the drivers are behind the rate increases," notes the CIHI's Kira Lee. "But whether it's a bad thing, we don't know."

In its report, Giving Birth in Canada: Providers of Maternity and Infant Care, the institute found that the trend reflects a number of factors.

They include an increase in the number of multiple births, such as twins and triplets, because of the increased use of fertility drugs and in-vitro fertilization.

As well, there has been a marked decline in recent years in the number of family doctors providing maternity care. According to the report, fewer than 19 per cent of family physicians billed for obstetrical services in 1999, compared with more than 30 per cent in 1989.

"While most family physicians still provide some maternity care, fewer are delivering babies than in the past," the CIHI said in a statement.

As a corollary, the institute says obstetricians attended 61 per cent of vaginal births and 95 per cent of all caesarean births in 2000. That was up five and two percentage points since 1996, respectively.

According to the president of the British Columbia Women's Hospital and Health Centre, family doctors seem wary of taking on birthing duties.

"Family doctors entering practice may believe that maternity care will add more stress to their already busy lives," Dr. Elizabeth Whynot said in a statement.

"Research on new family doctors suggests that confidence in obstetrical skills, fee structures and fear of malpractice suits are all factors that inhibit them from choosing to deliver babies as part of their practice."

In situations in which expectant moms can't be attended by their family doctor, they are often left with no alternative than to seek care in large hospitals. Scheduling C-sections, or surgical deliveries, at such busy institutions is a common practice.

The trend can be seen in the rural/urban divide across Canada.

"Small town/rural area family doctors are more likely to attend deliveries than their urban counterparts," the report said, noting 27 per cent of rural doctors reported delivering babies in 2001, compared with 12 per cent of those working in cities.

Many doctors believe caesarians have become a safer operation and cause fewer complications for both mother and child.

"The safety for babies has dramatically improved and the purely scientific data suggest there may in fact be an advantage to caesarean sections," explains Dr. Matt Gyser of Mississauga's Credit Valley Hospital.

Pediatrician Dr. Jack Newman disagrees, noting that C-sections require mothers to stay in hospital two days longer and can lead to surgical complications.

"There are wound infections that sometimes last for weeks and are difficult to get rid of," he says.

"Caesarean sections can be more than just benign. After all, it is major abdominal surgery, and I would avoid it if I had the choice."

Newman also warns that babies born by C-section can develop something called "wet lung syndrome," in which the baby who doesn't experience contractions during birth doesn't clear water from his lungs.

More turning to midwives

While surgical intervention in delivery may be on the rise, the institute notes that more Canadians are also turning to midwifery.

The number of jurisdictions regulating and funding midwives is growing countrywide, the report noted, pointing to Ontario as an example. The number of births attended by midwives in that province has risen seven-fold in five years, it said.

The CIHI report also pointed to a number of other trends, including Canada's declining overall birth rate. The average rate of 14.5 births per 1,000 people recorded in 1990-1991 fell in ten years to 10.5 per 1,000.

And of those Canadians who are starting families, they're doing so later in life.

Whereas only 34 per cent of Canadian babies were born to women older than 30 in 1991, by 2000 that group had grown to 42 per cent of all newborns.

The report released Wednesday is the first of four the not-for-profit CIHI plans to publish on the subject of giving birth in Canada this year.