Trends versus Tradition in Cesarean Surgery: Effects on Midwifery Practice and Cesarean Mothers’ Future Pregnancies

by Ina May Gaskin | June 1, 2007

Readers of Midwifery Today may remember my article in Issue 62 about a new trend—a faster way of suturing women’s uteri that came into vogue in the US in the 1990s. Formerly obstetricians in the US considered that in order for a uterine incision after c-section to heal properly it had to be closed in two layers and then a third layer added to close the peritoneum. The new minimalist method called instead for suturing the uterine incision in a single layer and leaving the peritoneum open. This one-layer suturing—also called the Misgav Ladach technique (1)—quickly became very popular among younger obstetricians, despite the dearth of research concerning its long-term safety implications. An obstetrician friend told me that the warnings of the older faculty members (“I wouldn’t do that, if I were you”) could easily be ignored because so much peer pressure was brought to bear on young residents to switch away from the traditional method to the new one.