No skilled practitioners

I thought my letter-writing days were over, but the headline “BC’s caesarean birth rate highest in country” (Vancouver Sun, 31 May 2007, p. A6) has driven me once more to the breach (no pun intended).

When I began practice at the old Grace Hospital almost 50 years ago (gasp!), the C-section rate threatened to exceed 5%. Accordingly, a portion of every monthly hospital meeting was dedicated to a critical review by the staff of all first sections. This seemed to keep the rate in check. 

Today, with the C-section rate having more than sextupled, I am aware of no reviews at all. The obstetrician can follow the line of least resistance with no fear of question or criticism from peers.

In the later years of my practice at Richmond Hospital, when making weekend rounds for my younger colleagues, I sometimes reviewed, unofficially, the charts of first-section patients. Often the indication for the operation was quite feeble indeed but almost always the doctor’s notes were very “convincing.” 

Dr Jan Christilaw, in considering “which factors are driving the high rate,” mentions increasing maternal age, increasing maternal weight, increased multiple pregnancy resulting from reproductive manipulation, cultural pressures, and doctor time-saving. I’m sure that each of these contributes. But she has omitted a factor which I consider to be the most important of all. Those obstetricians who were skilled at vaginal delivery have all disappeared. And a new crop is not forthcoming. There is no one to teach them.

I’m afraid, Dr Christilaw, that it’s too late to close the barn door. The horse is already halfway to Bellingham.

A. Krisman, MD

A. Krisman, MD. No skilled practitioners. BCMJ, Vol. 49, No. 7, September, 2007, Page(s) - Letters.

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