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Women undergoing C-sections with lower volume providers or specialists other than obstetricians are at much higher risk of complications.

Caesarean sections (C-sections) account for approximately 4.9% of all inpatient surgeries in New Brunswick and rates have been rising throughout Canada. 

NB-IRDT researchers looked at all hospital admissions for C-sections in New Brunswick between April 2004 and March 2014 (20,914 admissions). 71% of admissions were at one of New Brunswick’s four largest hospitals. 

The study considered the following complications: 

• Postpartum hemorrhage (blood loss greater than 500 ml);
• Postpartum sepsis, including puerperal peritonitis and puerperal pyemia; and
• Postpartum infection, including wound complications, urinary tract infections, and genital tract infections.

Researchers found at least one of the four identified complications in 2.6% of admissions over the study period.  

In all cases, patients of doctors who performed more C-sections per year had lower odds of complication.  For every additional C-section performed by an individual physician, the likelihood of complications decreased by 0.5%, which corresponds to a decrease of 4.5% for a 10 unit increase in annual caseload. 

Patients of physicians whose specialty was other than foetal-maternal medicine or obstetrics and gynecology experienced 40-50% more complications but the overall rate of complications was only 2.6%.  

Nearly all C-sections at higher volume hospitals were performed by foetal-maternal medicine and/or obstetrics specialists while nearly 18% of C-sections at lower volume hospitals were performed by providers with a specialty other than foetal-maternal medicine and/or obstetrics. 

Physician experience as measured in years since graduation was also negatively correlated with complications. Patients of physicians who were practicing for one additional year were 3.5% less likely to suffer from complications (16.3% less likely for a 5 year increase in years of experience). 

“A woman’s chance of experiencing complications is still quite low regardless of who performs the C-section,” says Dr. McDonald. “But the data shows that experience matters.” 

“Once physician experience and caseload volume are controlled for, there is little volume-outcome relationship remaining at the hospital level for C-sections,” says Dr. McDonald. “There is as much risk at a large hospital from a C-section performed by a a specialist who does few procedures per year as one done at a smaller, more rural hospital.” 

This study was authored by Dr. Phil Leonard, Dr. Dan L. Crouse, Jonathan Boudreau, Dr. Neeru Gupta, and Dr. Ted McDonald. It was published in BCM Pregnancy and Childbirth.