Indications for Cesarean Birth

In British Columbia, during 2015-2016, the main reasons for cesarean birth were:

  • Repeat cesarean birth (planned cesarean birth after having had a previous cesarean birth)
  • Dystocia (abnormal or difficult labour), includes failure to progress, incoordinate uterine activity, and cephalopelvic disproportion (i.e. large baby for maternal pelvis)
  • Fetal distress or non-reassuring fetal heart rate

While repeat cesarean accounts for the most cesarean births overall, labour dystocia and fetal distress are the most common indications for primary (first) cesarean birth.

Repeat Cesarean Birth

In BC, repeat cesarean birth accounted for 21.9% of all cesareans, or over 3,150 births in 2015/2016. Among women with a previous cesarean, 79.3% were eligible* for a vaginal birth after cesarean (VBAC), however only 34.1% of these women attempted a VBAC. Among eligible women attempting a VBAC, 69.3% had a vaginal birth.

*Most women are eligible for planning a VBAC if they have not had previous uterine surgery (other than their cesarean section). Women should discuss their eligibility with their healthcare provider.

Among facilities in BC with 1,000 or more births annually, in 2011/2012, rates of planned vaginal birth ranged from 22.6% to 41.1%. In 2015/2016, rates ranged from 22.1% to 39.3%. The graph below is sorted by facilities with most to least deliveries.

Attempted VBAC BCClick on graph to enlarge

Optimal Birth Evidence Review: Risks of VBAC compared to planned repeat cesarean birth

Labour Dystocia

The most common indication for primary cesarean birth in BC is labour dystocia or non-progressive labour. Cesarean section due to dystocia accounted for 15.3% of all cesarean sections in 2015/2016.

Labour that is not progressing normally may be augmented with synthetic oxytocin. In 2015/2016, 37.6% of labours were augmented in BC and of those, 49.3% were augmented with oxytocin. The rates of augmentation and use of oxytocin vary across health authorities.

Labour Augmentation BCClick on graph to enlarge

Labour Augmentation Oxytocin BCClick on graph to enlarge

Optimal Birth Evidence Review: Definition and diagnosis of dystocia.

Non-Reassuring Fetal Heart Rate or Fetal Distress

The second most common indication for primary cesarean birth in BC is non-reassuring fetal heart rate or fetal distress. Cesarean section for fetal distress accounted for 19.6% of all cesarean sections in BC in 2015/2016.

CS for Fetal Distress BCClick on graph to enlarge


Other practices that have been shown to be associated with cesarean birth are:

  • Admission to hospital before labour is established (See Optimal Birth Evidence Review: Triage).
  • Epidural analgesia (See Optimal Birth Evidence Review: Epidural).
  • Induction of labour for prolonged pregnancy (“post dates”) prior to 41 weeks gestation.