Main points of the article:
- The Ministry of Health ordered hospital managers in Israel to stop performing French Caesarean sections for fear of a high rate of complications compared to a normal Caesarean section.
- In French surgery, there is no cutting of the peritoneum, so the removal of the newborn is often done with forceps, which may cause complications for the newborn and the mother.
- The doctors of the Israeli Association for Obstetrics and Gynecology are afraid of the possible complications and emphasize that there is a lack of studies that indicate an advantage for a French caesarean section over a regular cesarean section.
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The Ministry of Health ordered to stop performing French caesarean sections
The Ministry of Health sent a letter to all hospital managers in Israel at the end of last week and ordered them to stop performing French caesarean sections, fearing a high rate of complications compared to a regular caesarean section.
The letter stated that the National Council for Gynecology, Neonatology and Genetics will hold a discussion in the coming weeks and examine the directive in light of the recommendations that will be received. It is also written that “in some hospitals, a deliberate unique rate will be charged for performing the surgery, which apparently is not in the basket of services approved by law. In the coming weeks, the course of the surgery and the possibility of receiving a different rate will be examined.”
The Ministry of Health addressed the issue of the high rate of the French operation, which until recently was only offered privately at Ma’aini Hashuah Hospital and the English Hospital in Nazareth, in amounts that climbed up to NIS 15-20 thousand per woman giving birth. A few months ago, the Shamir-Assaf Harofeh Medical Center included the surgery in the public basket, but it was only performed on mothers who met very limited criteria.
Recovery time after French caesarean section is shorter. The mother will be able to move about 3 hours later and will be released to her home about 36 hours later. Illustration: Shutterstock
According to the estimate of the Israel Midwives Association, about 36,000 cesarean sections are performed in Israel every year, which is about 20% of all births, the number of which is about 180,000 per year. The organization stated that “We believe that in the process of giving birth, the woman should be put at the center and she should always be allowed the right to choose. We believe that in every French caesarean section or regular caesarean section, special attention must be paid to the experience of the mother and we midwives lead the process paying attention to full guidance, personal accompaniment, providing an answer to the pain, during and after the operation.”
The Ynet website published the response of Dr. Israel Handler, a senior physician at the English Hospital in Nazareth, an expert in obstetrics and high-risk pregnancy and who brought the “French Caesarean section” to Israel. Dr. Handler opposes the decision of the Ministry of Health. “I want to believe in the Ministry of Health and hope that its representatives will hear the real data we have, so that a decision will be made that is more adapted to reality. The assumption that the French operation harms babies is unfounded,” he said.
French caesarean section – what are the risks?
The Israeli Association of Obstetrics and Gynecology published a draft of a position paper on the subject, where it was stated that “the association is troubled by the very common (80-90%) use of forceps/spatula to extract the newborn’s head in an elective caesarean section on time, as well as the lack of transparency regarding the use of forceps and the lack of awareness of analyzed for this fact. This fact,” it was noted, “may be related to a high incidence of scratches in the newborn.” It is also claimed that there is a lack of studies proving that the extraperitoneal method – in French caesarean section – has an advantage over normal surgery.
The Ynet website published the position of Prof. Yariv Yogev, director of the women’s and obstetrics department at Lis Hospital in Tel Aviv, who claimed that “in a study carried out at Bnei Zion Hospital, they tested the degree of pain, and there was no difference in pain between the two surgeries. More than that, there were more complications in the French operation – both damage to the bladder and the uterus itself.”
French caesarean section and the petition to the High Court
Following the Ministry of Health’s announcement that dozens of women fell ill, led by attorney Gilad Yitzhak Bar-Tal, a letter was sent to the Minister of Health Aryeh Deri and the Director General of the Ministry, Prof. Nachman Ash, in which it was stated that “Since there is no evidence to indicate harm following the operations from the French method, nor It is known about the complaints that were received on the subject, and in any case, this was not even determined by the aforementioned directive of the Ministry of Health, after all, stopping all surgeries immediately is an act that is extremely unreasonable and even lacks any professional legitimacy.”
What is a French C-section?
French caesarean section is an operation based on the extraperitoneal method in which access to the uterus does not involve cutting the peritoneum, also called the peritoneum, which is the membrane that protects the abdominal organs.
In a French caesarean section, the mother takes an active part in the birth and pushes, similar to a natural birth, and the baby is born through the open uterus, sometimes with the help of the surgeons who guide its exit with forceps. The operation should facilitate the process and at the same time allow the mother to experience the birth with full participation. In addition, it is claimed that French surgery is less painful and allows for a quick and easy recovery with fewer restrictions, including a faster discharge from the hospital.
The difference between a normal caesarean section and a French caesarean section
The accepted and common caesarean section in Israel is usually performed under local spinal anesthesia, but sometimes also under general anesthesia, when the operation is urgent or when an epidural does not have an effect. In most cases, it is better for the mother to fast so that she does not vomit during the operation.
In the surgery itself, first of all a catheter is inserted into the bladder. Then an incision is made in the abdomen, usually a transverse incision at the bottom of the abdomen (bikini line) and after that a cut is made of the connective tissue of the two longitudinal abdominal muscles and the two oblique abdominal muscles. The longitudinal muscles are separated from the connective tissue above them and the peritoneum – the membrane that covers the abdominal organs and intestines – is also cut. The bladder is removed and the uterus is opened with a lower transverse incision.
After cutting the uterus, the fetus and the placenta are extracted and the umbilical cord is cut. The incision in the uterus and the incision in the abdomen are sutured and the skin is closed with staples or stitches. A normal caesarean section is characterized by a recovery time of 6-8 hours, only after which the mother will be able to move around, and after five days of hospitalization she is discharged home.
A French caesarean section is also done through a transverse incision in the lower abdomen, like the one accepted in a normal caesarean section, but the steps of the incision and the internal surgery are completely different.
French caesarean section – the technique
In a French caesarean section, a catheter is not inserted into the bladder, which should reduce the risk of infections, injuries or urinary tract infections. The French operation also begins with a transverse incision in the lower abdomen. After that, the connective tissue above the muscles is cut lengthwise in the connective tissue above the left longitudinal muscle, without damaging the connective tissue of the right longitudinal muscle and the oblique muscles.
Many nerve cells pass through the connective tissue, and it links the muscle contraction to the ability to move. Reducing the damage to this connective tissue leads to a reduction in pain and greater mobility. After that, there is no separation of the longitudinal abdominal muscles but a separation of the muscle fibers to the left of the midline between the left longitudinal muscle fibers, so that a faster and easier recovery is possible.
The mother contracts the abdominal muscles and pushes the newborn out, sometimes the surgeon helps with forceps to guide his exit. Image: Shutterstock
Also, there is no cutting of the peritoneum membrane (peritoneum) that protects the abdominal organs, therefore fluids such as amniotic fluid or blood, or air do not penetrate into the peritoneum cavity, which reduces the risk of amniotic fluid embolism as well as a substantial reduction in pain and additionally reduces the chance for a bowel problem after surgery.
The extraction of the newborn in the French operation is different from the practice in a normal operation. The extraction is slow and much more similar to a normal birth, and is carried out with the help of a Gyaram blowpipe. Sivan Navot, a physiotherapist specializing in pelvic floor rehabilitation and a representative of the Gyaram method in Israel, teaches patients and professionals the method and the use of the ventilator during childbirth or surgery. The mother contracts the abdominal muscles and pushes the newborn out, sometimes the surgeon helps with forceps to guide his exit.
French caesarean section – is there a scar left?
The suturing of the uterus is done with a circular suture and not a longitudinal one as in normal surgery, which reduces the chance of bleeding and even weakening of the uterine wall, thinking about the next birth. At the end of the surgery, a subcutaneous suture is performed, the skin is glued with medical glue without staples or stitches.
In terms of recovery time and recovery after a French caesarean section, the woman giving birth will be able to move around 3 hours after the surgery, and about 36 hours later she will be released from her hospital. The recovery is accompanied by pain, but not such that it limits her movements and normal painkillers are enough to deal with it.
Questions and Answers
What is a French caesarean section??
A French caesarean section is a caesarean section based on the extraperitoneal method in which access to the uterus does not involve cutting the peritoneum, also called the peritoneum, which is the membrane that protects the abdominal organs. In a French caesarean section, the mother takes an active part in the birth and pushes, similar to a natural birth, and the baby is born through the open uterus, sometimes with the help of the surgeons who guide its exit with forceps.
How much does a French C-section cost??
Until recently, a French caesarean section was offered only privately in Ma’aini Hishu’a and Nazareth, for amounts that climbed up to 15-20 thousand shekels per mother.
French caesarean section – how to do it?
A French caesarean section is initially performed by a normal cut of the skin in a lower transverse section, later by strategic cuts that prevent damage to the connective tissues of muscles and their separation in order to reduce pain and limit movement during recovery. Also, there is no cutting of the peritoneum membrane that covers the abdominal organs and is called the peritoneum. Taking the newborn out is done through the mother’s pressures and blowing into a blowpipe, sometimes with the help of the surgeon using forceps.
What is the difference between a cesarean section and a French cesarean section??
In a normal caesarean section, a catheter is inserted into the bladder, and in a French caesarean section – not. Later, the cuts in the skin and tissues are made differently: in a normal caesarean section, more cuts are made with the aim of allowing a wide opening through which the newborn came out, including a cut of the peritoneum membrane that protects the internal abdominal organs. In a normal caesarean section, the birth mother does not take part in the delivery of the newborn, and in a French section she presses for it to come out.
The uterine and skin sutures are also done differently: in the French operation, the suture is circular and not longitudinal, and finally the skin is sutured using a subcutaneous suture and glue rather than using staples or stitches.