Imagine a surgical procedure so commonplace that it happens every second globally, yet its long-term impact on women’s health is only now being seriously questioned. That’s the reality of cesarean section closures, a topic that two leading experts in obstetrics and gynecology are urging us to reconsider. In a groundbreaking article published in the American Journal of Obstetrics & Gynecology, Dr. Emmanuel Bujold and Dr. Roberto Romero challenge the standard method of closing the uterus after a C-section, arguing that it may be doing more harm than good.
But here’s where it gets controversial: The technique most surgeons have relied on for the past 50 years—suturing the uterine lining and surrounding muscles together—is quick and minimizes immediate bleeding, but it fails to restore the uterus to its natural anatomical and functional state. This oversight, the authors argue, leads to a host of long-term complications, including placenta accreta (abnormal placenta attachment, affecting up to 6% of women), uterine rupture (up to 3%), and even increased risks of prematurity (up to 28%). Beyond these delivery-related issues, women may suffer from chronic pelvic pain (up to 35%), postmenstrual bleeding (up to 33%), and endometriosis/adenomyosis (up to 43%).
And this is the part most people miss: Dr. Bujold draws a striking analogy to illustrate the problem. He asks, ‘Would you suture a facial laceration by stitching together the skin, muscles, and oral mucosa? Of course not. So why do we treat the uterus differently?’ This simple yet profound question underscores the need for a more anatomically respectful approach.
The alternative technique proposed by Drs. Bujold and Romero involves suturing tissues of the same type—muscle to muscle—in two separate layers, with a third suture closing the uterine envelope. This method, while slightly longer (5–8 minutes compared to 2–3 minutes for the standard approach), prioritizes the long-term integrity of the uterus. ‘Meticulous restoration of the uterine structure should outweigh the speed of the procedure,’ Dr. Bujold emphasizes. ‘The future reproductive health of women must be our priority.’
Globally, cesarean rates are soaring—in Canada alone, nearly 27% of births are now C-sections, almost double the rate from 30 years ago. Given this trend, the authors argue that rethinking closure techniques is not just a medical necessity but a public health imperative.
Here’s the controversial question: Are we sacrificing women’s long-term health for the sake of surgical efficiency? Dr. Bujold and Dr. Romero say yes, and they’re calling for a paradigm shift. But what do you think? Is the extra time required for their proposed technique worth the potential benefits, or is the current method still the best option despite its drawbacks? Let’s spark a conversation—share your thoughts in the comments below!