Caesarean birth rates are on the rise. They are among the most common surgical procedures performed on women of child-bearing age. The national C-section rate has increased from 17 per cent of all births in 1995 to nearly 27 per cent in 2010. In addition, repeat c-section rates are more likely in Canada, with 82.5 per cent of women having them in 2011-2012.
What do we think about C-sections? Does the current standard of care ensure that women end up with only one C-section scar? Is an OB obligated to cut over a previous C-section scar?
Delivery by C-section and Multiple Incisions: Tal's Story
Three weeks after my 3rd C-section, I decided to take off my bandage and I was truly horrified. I saw a 2nd incision above my previous C-section scar. What on earth was this OBGYN thinking? I was shocked and angry and really felt violated.
I was lucky enough to be followed throughout my pregnancy by a wonderful OB at a Toronto Hospital. We discussed my previous scar (which healed perfectly) and she assured me she would remove my old scar, cut out the surrounding scar tissue, and give me a fresh incision for better healing. No woman wants a scar down there she doesn't absolutely need.
My water broke a few days before my scheduled C-section. Unfortunately my OB was not on call that day and one of her colleagues performed the C-section. (This, in and of itself, is a questionable practice in Canadian hospitals -- but a topic for another article.) I was not an emergency case. I was in labour, with no epidural, for hours before I was taken into the operating room. In fact, my time kept getting pushed back because there were serious cases that came up.
I was exhausted and excited to meet my baby, and it really didn't occur to me to remind the doctor on call to cut over my previous C-section. You would think this was common practice and that there were notes in my file about my discussions and expectations for this procedure.
Was he careless? Was he disrespectful? Was he in a rush? Was it just easier for him to make a new incision? Would a woman OBGYN have approached this differently? I still don't know the answer, but I suspect it was a combination of all of these.
When I approached my OB at my follow-up appointment, she was in shock as well. She took one look at my scar and couldn't believe what she saw. She offered to talk to the doctor that performed my C-section, but I told her not to bother. I was so upset by what had happened and was hoping I'd forget about it and the disappointment would just pass.
More than a year has gone by, and I can assure you that a day has not passed where I have not thought about it with varying degrees of sadness. At this point it's only for a brief moment, usually when I'm in the shower, but nonetheless I feel terribly let down. I do realize in the grand scheme of things, my second incision is not the biggest deal. I have a fourth healthy baby, I healed quickly, and my husband could not care less about any imperfection my pregnancies have caused me. However, this does not make it OK.
I now have two scars and my C-section tummy is worse off because of it. The first two scars healed in a straight, clean line below my bikini line. I barely had that well-known flap every C-section mom fears. Dr. Ziegler, at the Montreal Jewish General Hospital, performed my first two surgeries and he did an amazing, clean job. My third, most recent scar, is slightly above the bikini line. If you've had a C-section then you know this is bad news. And, I'm not the kind of person that is going to have a tummy tuck.
I decided to share this story for a couple of reasons that we discuss below; but mostly, because I don't want this to happen to any other mother.
C-section Delivery Standard of Care and Other Considerations for the Medical Community
First, OBGYNs have a duty to perform a C-section in accordance with the medical standard of care set by other doctors in the community. This standard of care must include cutting over a previous scar. Every doctor performing a C-section -- regardless of whether he/she followed you during your pregnancy -- owes this to you. They must take every step possible to ensure you end up with only one scar. This is standard practice today and it's what women expect.
Second, while we believe most doctors do not have bad intentions, we think it's important to remind OBs that the operating room is not an assembly line. What you do in that operating room impacts a woman's life permanently. Think of your mother, wife or daughter, and how you would want her to be treated. And find it within yourself to treat every patient like that.
Third, hospital administrators need to address this issue with doctors. An unnecessary second incision could have a significant negative impact on someone, especially someone with serious body image issues. It could impact that person's happiness and mental state, resulting in medical malpractice suits against hospitals. All this could be avoided with a little bit of education. There are numerous stories online of doctors performing sloppy C-sections in Canada and this is totally unacceptable.
Ask yourself -- If this happens, who should incur the cost of cosmetic surgery to fix the problem?
Authors Tal Srulovicz and Stephanie Kleiman are co-owners and editors-in-chief of Her Magazine.
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