Spreading Our Wings
Empowering pregnant women at risk of emergency c-section
A new questionnaire predicts risk of an emergency cesarean delivery and could allow time for interventions to avoid the procedure
Almost one in every three babies in Canada is delivered by cesarian section (c-section) rather than vaginal delivery. The rate has been growing steadily since the early 1980s when just one in 20 babies were delivered surgically.
C-sections have small but significant risks for mothers, such as infections, blood loss, blood clots, bladder injury and other complications. Women may also suffer mental health difficulties if a cesarean delivery is performed on an emergency basis, as the experience can be distressing or even traumatic.
Department of Pediatrics professor Piush Mandhane is leading a project to measure the effectiveness of an assessment tool, a short questionnaire that allows physicians and pregnant women to assess their emergency c-section risk ahead of labour. “Existing tools are meant for women already known to be at high risk of c-sections — like those with prior c-sections — or women already in active labour,” he says. “We could not identify anything available to help women and their doctors manage the risk of a potential emergency c-section.”
The new emergency cesarean delivery risk prediction model is designed for women in low-risk pregnancies and can predict their likelihood of c-section at any stage of pregnancy. The information gives doctors time to refer patients for psychological counseling to prepare for a potential emergency c-section, as well as health interventions like weight management programs that may help prevent the procedure.
The development of the prediction model was led by Mandhane’s former PhD student and trainee Tun Mon, and a team of researchers including Mandhane and fellow WCHRI member Padma Kaul. The questionnaire was developed using data from the CHILD birth cohort study. CHILD, a large longitudinal project that Mandhane helps lead, has been gathering data on the health of more than 3,400 Canadian children, as well as their mothers, for over 12 years. The final version of the emergency c-section questionnaire is based on six variables, including hypertension, antenatal depression, previous vaginal delivery, age, height and BMI.
After completing the model, the team published a research paper in October 2022, but Mandhane notes that a single paper cannot change the practice of medicine. Now, he and a team of researchers are testing the model — a three-minute questionnaire — in Brazil (work being led by graduate student Fabiana Mamede, a nurse-midwife), rural Alberta (Grande Prairie and Red Deer) and Edmonton. Once the tool is validated in these settings, Mandhane and his team hope to take it to specific populations of people, including Indigenous communities in Alberta.
Validating a model like this is good science, says Mandhane, but it can be difficult to gather funding for validation work. “Without WCHRI support, this work would be just another research paper sitting on a pile of a billion other papers.”