Why so many C-sections?
Sharon Kirkey, The Ottawa Citizen; Canwest News Service
Published: Saturday, August 01, 2009
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.
“You get into this place where you think, OK, this is what I’m trained to do, I know exactly how to do this,” says Christilaw, who was a senior resident at the time. “You don’t panic, but you’re calling in everybody you can possibly get into the room.” People had to squeeze the bags of blood, because the pump could not put it in fast enough.
The only way to stop the bleeding was an emergency hysterectomy. The woman was in the operating room for eight hours, and lost 15 litres of blood.
It used to be that obstetricians might see one or two cases of placenta accreta in their practice lifetime.
Although still rare, placenta accretas — one of the most feared complications of pregnancy — are increasing as a consequence of the rising caesarean section rate, say obstetricians across Canada.
Virtually all placenta accretas occur in women who have had a previous C-section, and the risk increases with each additional one. The placenta attaches to the old C-section scar. Scars don’t have a proper blood supply to feed a placenta, so it keeps burrowing into the uterus until it finds one, sometimes pushing through the uterus into the bladder or other organs.
Ultrasound can detect the condition, but not always. “You almost never see it in a woman who has not had a C-section,” Christilaw says.
Today, about 28 per cent of babies born in Canada are delivered by caesarean. In 1969, Canada’s rate was five per cent.
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