Providing women with early knowledge about childbirth could help reduce unnecessary cesareans

Cesarean deliveries in most developed countries, including Canada, are at least 10 to 20 per cent higher than recommended by the World Health Organization, and many efforts to decrease unnecessary C-sections have failed. But a new University of British Columbia study suggests that providing women with early knowledge about pregnancy and childbirth could help reduce these numbers.

UBC researcher Kathrin Stoll studied young women from eight middle and high-income countries and found that at least 10 percent would prefer to deliver via cesarean even when the procedure is medically unnecessary, largely out of fear. Eight out of 10 women surveyed cited worries about labor pain, and six out of 10 were anxious about perceived physical damage from labor and birth.

But having sufficient information on childbirth seemed to make a difference. Of the 2,043 women who were sufficiently comfortable in their birth knowledge, only nine percent said they would prefer cesarean in a healthy pregnancy. Among the 1,346 women who lacked that confidence, the proportion rises significantly to 14 percent.

"Reducing unnecessary cesareans is important because abdominal surgery is linked to a higher risk of complications for the mother and baby and higher healthcare costs compared to vaginal births," said Stoll, a postdoctoral fellow in the school of population and public health and the division of midwifery in UBC's faculty of medicine.

The study found that young women who preferred cesarean delivery had several knowledge gaps and misperceptions about childbirth that could be addressed through education.

"We should be providing women and men with information about childbirth early on, as early as elementary or secondary school, before their attitudes towards birth become too influenced by media dramatizations and other sources that aren't evidence-based," said Stoll.

The researcher cautions that more studies are needed to find out the best way to deliver this education. In the next stage of her research, she will test a promising midwife-led childbirth education program, currently practiced in Germany, for primary school children in Canada.


The study, published recently in Reproductive Health, examined survey data from 3,616 childless women in Australia, Canada, Chile, England, Germany, Iceland, New Zealand and the United States. The average age of participants was 23 years old. The Canadian Institutes of Health Research, the Michael Smith Foundation for Health Research and Curtin University in Australia provided funding.

Stoll has just completed a review of interventions for pregnancy anxiety and childbirth fear. She is currently studying childbirth fear among women in Vancouver and on Vancouver Island with colleague Nicole Fairbrother, director of the perinatal anxiety research lab at UBC.. Stoll is an active member of the Birth Place Lab at UBC.


  1. Pauline Hull Pauline Hull Canada says:

    It's bad enough that women are not always given balanced, unbiased information about the comparable risks of different birth plans, but to suggest introducing this situation at elementary school is highly questionable.
    Many women who choose a caesarean are concerned about urinary and fecal incontinence, pelvic organ prolapse and impact on sexual health. They are also concerned about stillbirth, infant injuries and the unpredictability of labour. Most children at elementary school won't be knowledgeable about or concerned about these issues at that stage in their life, but they will learn about and may be 'influenced' by them later on.
    It concerns me as a mother of primary school aged children that such a study, with the goal of 'reducing caesarean rates' might secure ethics approval in Canada.

    Incidentally, caesarean rates in most developed countries are considerably higher than 10-20% above the WHO's recommended rates of 10-15%...

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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