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

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.
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About Author: Ina May Gaskin

Ina May Gaskin, CPM, is the founder and director of The Farm Midwifery Center in Tennessee (USA). She is the author of Spiritual Midwifery (1975) and Ina May’s Guide to Childbirth (2003). Ina May’s new book (2011) is called Birth Matters: A Midwife’s Manifesta. She was president of Midwives Alliance of North America (MANA) from 1996 to 2002, and is a prominent national and international speaker. She has been a homebirth midwife since 1971.

Photo by Andrea Noll

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