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
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org