Web Extra Article - Health

C-Section may lead to hysterectomy

by Reuel S. Amdur

A research study carried out at Britain's Oxford University on the long-term effects of caesarean operations has found that women who have a caesarean section in childbirth are much more likely to require a hysterectomy after an additional childbirth.

One reason that a hysterectomy may be needed on the occasion of the next birth is the tendency of the placenta to grow low on the wall of the uterus or on the scar left by the caesarean.

While the World Health Organization has set a standard of 15 per cent maximum for deliveries by C-section, rates vary widely. In 2005-2006, more than a quarter of all Canadian births were by caesarean. The rate in Edmonton is comparable, but hospitals elsewhere in the province have rates varying widely in both directions.

Why would a C-section be needed? There are many possible reasons, such as risk of complications. Risks increase when a woman is over 35 and/or overweight. Also, if a baby has a large head, a C-section may be indicated. However, many caesareans are performed for convenience, either for the convenience of the mother or of the doctor.

It has been shown that C-sections are less common when a midwife is involved in the procedure, but midwifery is not paid for under Alberta health insurance, except for a project in Stony Plain. Yet, costs of C-section births are much higher than for normal births - in the range of $6,000 versus $3,600.

Granting that the need for a hysterectomy in case of an additional birth after a C-section is substantially higher than for women who do not have one, it can be argued that the rate is still not so high.

For women who have a normal birth, bleeding complications result in a need for surgery in one of 30,000 cases. If a woman has had a C-section, the rate is one in 1,300, and with two or more, the rate climbs to one in 220. Yet, not many women today would feel deprived if they could have only two children.