Birth at a Crossroads: Cesarean Trends and the Need for Broader Care Options

Birth is profound. It marks the opening of a new chapter for our bodies, our infants, and our families. Yet in British Columbia, the growing number of cesarean births signals a need to rethink the choices available to birthing people—especially when access to out-of-hospital, midwifery-led care remains limited, or misinformed // not promoted to the wider population. 

In 2023–24, the overall provincial c-section rate in BC stands at approximately 37%, dramatically higher than the Canadian average of 28%, and well above the World Health Organization’s recommended maximum rate of 10–15%. BC continues to hold the highest cesarean rate in the country. This is not just a matter of statistics; it has real implications for health and well-being.

The World Health Organization’s recommended limit of 15% is based on clear evidence that c-sections above this threshold provide no added benefit—and in fact carry additional risks. Higher rates are linked to increased chances of infection, placental complications in future pregnancies, longer hospital stays, and challenges in recovery. Beyond medical consequences, these interventions shape the birth experience itself, often leaving families feeling disempowered or disconnected from the process.

Evidence shows that care models make a real difference. Babies born under midwifery care have much lower c-section rates: among low-risk clients in BC, just 7.2% of those with midwives had cesareans, compared to 12.2% under physician-led care and a striking 43.2% under obstetrician-led births. Yet despite these clear benefits, only about 15–25% of births in BC currently involve a midwife—even though midwives are trained, regulated, and deliver safer outcomes across all medical risk profiles.

Midwife-led models offer continuity of care throughout pregnancy, birth, and the early postpartum period. They provide an integrated approach within the healthcare system while prioritizing normal, physiologic birth and respecting each person’s unique needs and values. Hundreds of studies confirm the benefits of these models—not only in reducing interventions but in fostering trust, safety, and dignity during birth.

Despite being part of BC's publicly funded healthcare system, midwifery services—especially out-of-hospital options—remain difficult to access for many. Hospital capacity constraints, funding models that don’t always support midwife-led births, and the limited number of registered midwives (around 536 for more than 40,000 births each year) mean that families wanting home or birth-centre options often face long waits or find no space at all. These barriers are even more acute in rural, Indigenous, and remote communities, where lack of continuity and access to providers can be severe.

Without expanding these lower-intervention, client-centered models, we risk further medicalizing normal birth. We risk denying families access to the settings that best align with their cultural, emotional, and personal needs. And, ultimately, we risk perpetuating high c-section rates not because they’re medically necessary, but because families aren’t being offered real choices.

I believe every individual and family deserves truly informed choice throughout pregnancy and birth. We should be asking ourselves: What are the real benefits and risks in our own hospital or region? Are we being offered balanced options that reflect evidence, not just institutional convenience? Could a midwife-led, home, or birth-centre option be right for us?

This is not just about statistics. It’s about trusting the body, supporting informed consent, and ensuring all families have real access to safe, lower-intervention birth models. It’s about expanding midwifery services—especially home and birth-centre care—making hospital c-section rates transparent, investing in continuous community education on the risks and alternatives to intervention, and ensuring culturally safe, accessible care for rural and Indigenous communities.

At Nurture North, I support people on every birth path—whether they choose hospital, home, VBAC, or primary cesarean. My role is to help you understand your options, support your body’s rhythm, and provide care that honours your values.

I invite you to reflect: Have you been fully informed about your birth options? Would greater access to midwifery and out-of-hospital care change how you feel about birth?

It’s time to listen—to our data, our bodies, and our values—and to reclaim birth as the powerful, embodied experience it is meant to be.