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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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Reader Comments (2)

but we all know what the main reasons are. The Canadian Institute for Health Information (CIHI) has already pull the data for us. We know that the main reason is the fear of litigation. For the med minds (not just doctors but also lots of midwives) it is better to be doing something even if you get a bad outcome rather than not doing anything and still have a bad outcome.
It's all about money. We need to start changing the health policy. We need to do a radical shift from having these marvelously trained highly specialized surgeons care for healthy women. They are trained in pathology and how to deal with things that are not working, emergencies.
We need continuous support for pregnant families from conception (or even before that) to postpartum and early years. We need to have women's centers through out the cities where there would be midwives, doulas, breastfeeding counsellors, and a ray of other support professionals based on demand available to the families.
But we need to cut the red tape. We should learn from legislating midwifery that having the govt involved is not always a good thing. There needs to be a limit to their involvement or the services will again turn into medicalized services that will not bring anything about. Maybe non-profit organizations nation-wide, receiving some grants and support from the govt but still be accountable to the communities they serve?
Hmmm. My rant for today.
Happy Birthing and a productive World Breastfeeding Week.
Keep up the good work :)


August 2, 2009 | Unregistered CommenterVeronika

I'm so glad this article came out. I found it refreshingly honest, actually. I don't know how anyone could read this and not get how essential it is to be ENCOURAGING more VBACs, not restricting them!

I'm curious to see what their take on "too push to push" will be. Everything I've ever read says that the actual number of elective, maternal request cesareans makes up about 1% of them, and that doctors blaming patient choice is really just some outlandish scapegoating, which just happens to be supported by a few unfortunate celebrity examples. It seems to me to be much more about perception, and doctors trying to avoid taking responsibility, than it is about reality.

August 2, 2009 | Unregistered CommenterDou-la-la
This blog is all done!
Thanks for wanting to comment. This is an archive of a blog that once was. Take care! Jill