• Shiliang Liu, I D Rusen, K S Joseph, Robert Liston, Michael S Kramer, Shi Wu Wen, Robert Kinch, and Maternal Health Study Group of the Canadian Perinatal Surveillance System.
• Health Surveillance and Epidemiology Division, Centre for Healthy Human Development, Health Canada, Ottawa, ON.
• J Obstet Gynaecol Can. 2004 Aug 1; 26 (8): 735-42.

ObjectiveTo examine recent trends in Caesarean delivery rates as well as the indications for Caesarean delivery in Canada, excluding the provinces of Manitoba and Quebec.MethodsAll deliveries (N = 1 807 388) recorded in the Canadian Institute for Health Information's Discharge Abstract Database for the years 1994/95 to 2000/01 were included in the study (all hospital deliveries in Canada except for those occurring in Manitoba and Quebec). Temporal trends and inter-provincial/territorial variations in Caesarean delivery rates were quantified, and the primary indications for Caesarean delivery during the study period were compared.ResultsThe overall Caesarean delivery rate increased from 18.0% in 1994/95 to 22.1% in 2000/01. The primary Caesarean delivery rate increased from 12.7% to 16.3%, while the rate of vaginal birth after Caesarean decreased from 33.3% to 28.5% over the same period. Most of the increase in primary Caesarean deliveries was due to increases in Caesarean deliveries for dystocia, which increased from 6.9% in 1994/95 to 9.2% in 2000/01. The largest increase in repeat Caesarean deliveries was due to elective repeat Caesarean sections, which increased from 37.7% to 40.3%. Approximately 15% of the increase in overall Caesarean delivery rates was explained by increases in maternal age. The rate of vaginal deliveries following forceps rotation declined from 1.9% in 1994/95 to 1.3% in 2000/01.ConclusionMost of the recent increase in Caesarean delivery rates in Canada was attributed to increases in primary Caesarean delivery for dystocia and elective repeat Caesarean deliveries.

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