Ottawa Citizen asks "Why so many c-sections?"

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The Ottawa Citizen published the first part in a three part series on cesareans on August 1, 2009, entitled Why so many c-sections?

Dr. Jan Christilaw was in the operating room the day a routine incision was made into a young mother’s abdomen to deliver her baby.

What happened next, says Christilaw, “is something we never want to see.”

Normally, the placenta separates from the wall of the uterus after birth. It’s lacy almost, and not like solid tissue. “You can take your hands and sort of scoop it up, it’s like breaking cobwebs as you go,” says Christilaw, an obstetrician and president of B.C. Women’s Hospital and Health Centre in Vancouver.

But the placenta had eroded through the wall of the uterus, a condition known as placenta accreta. As soon as they stretched the opening of the uterus to deliver the baby, “the placenta started bleeding everywhere.”

They couldn’t stop the bleeding. The woman was losing two cups of blood every 30 seconds.

The woman had an emergency hysterectomy, spent eight hours in the operating room and lost 15 liters of blood. Placenta accreta is a placenta that attaches itself too deeply and too firmly into the wall of the uterus and nearly all placenta accretas occur in women who have had a previous cesarean. An increase in placenta accretes has followed the huge influx in cesareans performed.

Also interviewed for the article was Dr. Michael Klein, emeritus professor of Family Practice and Pediatrics at the University of British Columbia. Klein was one of a number of experts asked by the NIH to review the systematic evidence review prior to the 2006 NIH conference on “Cesarean Delivery on Maternal Request.” In Pushed by Jennifer Block, Klein called the evidence review so fundamentally flawed that it couldn’t be fixed and was critical of the their failure to even look at the huge amount of morbidity associated with subsequent births.

Dr. Michael Klein calls it the industrialization of childbirth, where, in today’s risk-averse society, women in labour are being treated “as an accident waiting to happen” and where doing something is always better than doing nothing.

“Physicians and society have helped women basically believe that childbirth is no longer a natural phenomenon, but an opportunity for things to go wrong,” says Klein, emeritus professor in the departments of family practice and pediatrics at the University of British Columbia. “But the fundamental issue is, we aren’t improving outcomes by doing more C-sections. For the first time in Canada, we are seeing the key indicators for mothers and babies going in the wrong direction.”


The second part in the series was published today. In C-sections and motherhood, a few hypotheses on cesareans and delayed bonding were addressed.


The article Too posh to push is next in the three part series.

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