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Twins Study Findings Reduce Health Risks and Costs

Researchers at Sunnybrook find no advantage to having a cesarean section over a vaginal birth in terms of mitigating risks for twin births. With an estimated 5,700 twins born in Ontario each year, the recommendation for vaginal delivery could save the system between $3-8 million annually.

Ontario’s health research enterprise continues delivering significant results that make our province healthier and wealthier. While the results that make Ontarians healthier are often more obvious, these research findings can also make our province wealthier, which is just as important. Recent research on the risks associated with multiple births at Sunnybrook Health Sciences Centre has shown to benefit both of these categories, reducing risks for Ontarians while reducing costs for the system. In fact, an economic analysis demonstrates that this finding could save the system between $3 – 8 million each year.

Multiple Births: A Growing Trend

Multiple births is a relevant topic. Over the past two decades most developed nations have seen an increase in the rate of twins and multiple pregnancies, driven by the use of assisted reproductive technologies such as in-vitro fertilization and ovulation-stimulating drugs. Here in Canada, we had about 8,000 twin births in 1993. By 2013 that annual number had grown to about 12,000.

The Safer Option – C-Section or Vaginal Birth?

As the rate of multiple births has risen, Ontario’s experts have debated the safest option for delivering twins – cesarean section (commonly referred to as C-section) or vaginal birth? Public perception may tend to view C-section as the safer option, but a 2013 study led by Dr. Jon Barrett, director of Sunnybrook’s Women & Babies Research Program and the Fred Waks Research Chair holder, found that delivering twins by planned vaginal birth was as safe as delivering the twins by planned C-section.

It’s a significant finding with the potential to change thousands of birth plans each year.  As Dr. Barrett says, “If you can get an equally safe result without doing surgery, why would you choose surgery?”

With an estimated 5,700 twins born in Ontario each year, the recommendation for vaginal delivery could save the system between $3-8 million annually.
With an estimated 5,700 twins born in Ontario each year, the recommendation for vaginal delivery could save the system between $3-8 million annually.

Cost Savings

The economic impact is equally meaningful, as the average cesarean section costs $2,124 more than a vaginal birth. When we look at the overall numbers, these savings add up.

An economic study recently published by the Centre for Excellence in Economic Analysis Research (CLEAR) offered the following analysis:

  • In 2013-2014, Ontario had almost 5,700 twin births
  • Approximately 30-40% of birth mothers cannot have a vaginal birth
  • However, by following the best practice of choosing a vaginal birth, the remaining 60-70% of birth mothers can mitigate their health risks

The CLEAR analysis concludes that following Dr. Barrett’s best practice of choosing vaginal delivery of twins over C-section could potentially save $3-8 million per year in Ontario.

Twin Birth Study

Led by Dr. Barrett, Sunnybrook Research Institute’s Twin Birth Study looked to see if there were differences between twins born by vaginal delivery compared to those born by C-section.

Dr. Jon Barrett, director of Sunnybrook’s Women & Babies Research Program and the Fred Waks Research Chair holder.
Dr. Jon Barrett, director of Sunnybrook’s Women & Babies Research Program and the Fred Waks Research Chair holder.

The Research Summary is available here: http://sunnybrook.ca/research/content/?page=sri-proj-cmicr-trial-tbs-summ

After excluding cases with complications, this comprehensive trial enrolled 2,804 women giving birth at 106 centres in 25 countries across North and South America, Europe and the Middle East. Women pregnant with twins at 32-38 weeks gestation were then randomly assigned to either undergo a C-section or give birth vaginally.

Researchers examined differences in outcomes such as deaths during delivery, severe infant complications and evidence of brain damage, and found these outcomes in 2.05 % of babies born by C-section and 1.87 % those born vaginally – an essentially equal result.

A Reassuring Choice for Patients

Some patients and caregivers may still regard C-section as the safer option, but they can rest assured that evidence is showing that for healthy pregnancies, the risk factors are essentially equal.

As this best practice becomes more widespread among practitioners and patients, there is real potential for overall cost savings.

 

This research is one example of how Sunnybrook Health Sciences Centre is contributing to a healthier, wealthier, smarter Ontario. Learn more at www.healthierwealthiersmarter.ca.