Deliveries can occur either before labour, during the first stage of labour (prior to full cervical dilation), or during the second stage of labour (after full cervical dilation. In Canada, the distribution of deliveries between vaginal and cesarean delivery (CD) is well established as approximately 70% and 30% of all deliveries, respectively. However, the proportion of CDs that occur in the 2nd stage of labour has not been defined in Canada. As a result, patterns in obstetric practice related to mode of delivery in the second stage of labour are unknown, and potential shifts in these practices over time have not been assessed.
The rate of CD has increased steadily in Canada and worldwide over the last three decades due to a variety of reasons, including higher rates of advanced maternal age, comorbid conditions such as gestational diabetes, pre-existing diabetes, chronic hypertension and other chronic diseases, obesity and patient request for primary CD. Concurrent decreases in rates of operative vaginal delivery (OVD; forceps and vacuum delivery) have also been observed and often attributed to the same reasons, as well as shifts in obstetric training (fewer opportunities for training in OVD) and increased awareness of the frequency and impact of obstetric trauma following OVD. The decrease in OVDs suggests that second stage CDs are also increasing; however, population estimates of temporal trends in second stage CD are far less common and only isolated reports have shown increases in this subset of CDs. Thus, the temporal trends in second stage CD, forceps, vacuum have yet to be characterized and the impact of potential shifts in operative delivery use on maternal and perinatal morbidity rates has not been studied.
The rate of CD has increased steadily in Canada and worldwide over the last three decades due to a variety of reasons, including higher rates of advanced maternal age, comorbid conditions such as gestational diabetes, pre-existing diabetes, chronic hypertension and other chronic diseases, obesity and patient request for primary CD. Concurrent decreases in rates of operative vaginal delivery (OVD; forceps and vacuum delivery) have also been observed and often attributed to the same reasons, as well as shifts in obstetric training (fewer opportunities for training in OVD) and increased awareness of the frequency and impact of obstetric trauma following OVD. The decrease in OVDs suggests that second stage CDs are also increasing; however, population estimates of temporal trends in second stage CD are far less common and only isolated reports have shown increases in this subset of CDs. Thus, the temporal trends in second stage CD, forceps, vacuum have yet to be characterized and the impact of potential shifts in operative delivery use on maternal and perinatal morbidity rates has not been studied.
Related publications
Temporal trends in second-stage cesarean birth in Ontario, Canada, 2012–2021
Vanessa Hébert, Sheryll Dimanlig-Cruz, Giulia M. Muraca
O&G Open, vol. 2(3), 2025, pp. e084.
Delivery in the second stage of labor and preterm birth in a subsequent pregnancy: a response
Abirami Kirubarajan, Giulia M Muraca
American Journal of Obstetrics and Gynecology, vol. 231(6), 2024, pp. e227-e228
Tzuria Peled, Giulia M Muraca, Miri Ratner, Hen Y Sela, Abirami Kirubarajan, Ari Weiss, Sorina Grisaru-Granovsky, Misgav Rottenstreich
International Journal of Gynaecology and Obstetrics, vol. 166(2), 2024, pp. 775-82
Tzuria Peled, Giulia M Muraca, Miri Ratner, Hen Y Sela, Abirami Kirubarajan, Ari Weiss, Sorina Grisaru-Granovsky, Misgav Rottenstreich
American Journal of Obstetrics and Gynecology, vol. 230(1), 2024, pp. S477-S478
Abirami Kirubarajan, Nila Thangavelu, Misgav Rottenstreich, Giulia M Muraca
American Journal of Obstetrics and Gynecology, vol. 230(3), 2023, pp. 295-307.e2.
Giulia M Muraca, Sarka Lisonkova, Yasser Sabr, Amanda Skoll, Rollin Brant, Geoffrey Cundiff, KS Joseph
American Journal of Obstetrics and Gynecology, vol. 216(1), 2017, pp. S521-S522
Operative delivery options in the second stage of labour : optimizing maternal and perinatal safety
Giulia M Muraca
University of British Columbia, Vancouver, British Columbia, Canada, 2017