• Klein, Michael C.


    Investigator Emeritus, BC Children's Hospital
    Emeritus Professor, Department of Family Practice, University of British Columbia
    Honorary Member, Departments of Family Practice and Pediatrics, BC Children's Hospital and BC Women's Hospital & Health Centre

    Degrees / Designations
    Primary Area of Research
    Evidence to Innovation
    Secondary Area(s) of Research
    604-737-1757 / 604-740-0150 / 604-760-4270
    Lab Phone
    Mailing Address
    Affiliate Websites
    Research Areas
    • Normal pregnancy
    • Pelvic floor functioning
    • Old and new technologies in birth
    • The "caesarean section on demand" debate
    • New models of primary maternity care-including family practice maternity services
    • The safety of rural and remote maternity care
    • The place of maternity care in rural community sustainability

    I am best known as principal investigator for the only North American randomized controlled trial of episiotomy, which showed that episiotomy caused the very problems it was supposed to prevent.

    I have continued to focus on best practices in maternity care to help achieve optimal outcome for mothers and newborns. We continue to study the attitudes and beliefs of all those who care for women in their pregnancies and births – family physicians, obstetricians, midwives, nurses, doulas and trainees in these disciplines – as well as the women themselves. These studies demonstrate that attitudes have direct impact on outcome.

    The health of rural communities and the place of maternity care in sustainable communities, as well as related areas of safety of rural maternity care and optimal strategies for safe maternity care in any setting, continue to be the focus of my work.

    Current Projects

    Our study, "Does delivery volume of family physicians predict maternal and newborn outcome?" (CMAJ, April 2002) on the lack of association between low volume maternity practice and adverse outcome has already led to a rescinding of the Society of Obstetricians and Gynaecologists of Canada (SOGC) Policy on Low Volume Obstetrics and the creation of a new one based on a collaboration between the SOGC, College of Family Physicians of Canada (CFPC) and Society of Rural Physicians of Canada (SRPC) indicating that low volume is not a problem.  With colleagues across BC and Canada we research approaches in low volume (usually rural) settings. For example, with Dr. Colin Yarow in Kelowna we have shown that vacuum extraction by family physicians is safe. This is the first study by family physicians on this technology.

    Our study "In for the Long Haul--determinants of sustainable practice" (Can Fam Physician, June 2002) tests and evaluates both curricular and practice based interventions in the promotion of safe sustainable practice. We have begun a similar project with Halifax colleagues to determine if the sustainability issues found in BC are similar in Nova Scotia. Similar projects are underway with collaborators in Montreal, Toronto, Ottawa and several rural settings for this and the volume studies. We have published papers on the difficulties of centralization.  These studies have led on to our current series of studies on the attitudes of all providers of maternity care and the women themselves.

    We are heavily involved in the caesarean section on demand debate and

    have published original research on pelvic floor functioning in relation to vaginal vs. caesarean birth and are working on a critical review of pelvic floor functioning by mode of birth. We are now looking at the attitudes of ethnic communities toward caesarean by choice. A linked study of the impact of epidural analgesia on caesarean section rates is in progress as well as a new study (with Andrew Kotaska PI) on high vs. low dose oxytocin augmentation in the presence of epidural analgesia.

    Working with Patti Janssen, we have completed a series of five studies on single room maternity care and are engaged in the long term study of home birth in BC.

    We are beginning a study on the place of maternity care in rural community sustainability – this in collaboration with the SFU Centre for Sustainable Community Development.

    Selected Publications

    Manville M, Klein MC, Bainbridge L. Improved outcomes for elderly patients who received care on a transitional care unit. Canadian Fam Physician. May 2014;60(5):e263-e271.

    Johnston CS, Klein MC, Iglesias S, Avery G. Competency in rural practice. Can J Rural Med. 2014 Spring;19(2):43-6.

    MacKay FD, Anderson JE, Klein MC, Berkowitz J, MacKay JT, Gailius J. The modified medical office assistant role in rural diabetes care. Can J Rural Med. 2014;19(2):49-57.

    Amram N, Klein MC, Simkin P. How birth doulas help clients adapt to changes in circumstances, clinical care, and client preferences during labor. Journal of Perinatal Education. In Press 2014. 

    Janssen PA, Livingstone VH, Chang B, Klein MC.: Development and evaluation of a Chinese-language newborn needing hotline: a prospective cohort study. BMC Pregnancy Childbirth. 2009 Jan 29;9:3.

    Tan WM, Klein MC, Saxell L, Shirkoohy SE, Asrat G.: How do physicians and midwives manage the third stage of labor?. Birth. 2008 Sep;35(3):220-9.

    Klein MC, Kaczorowski J, Firoz T, Hubinette M, Jorgensen S, Gauthier R. A comparison of urinary and sexual outcomes among women experiencing vaginal and Cesarean birth. Journal Obstetrics and Gynecology Canada . April 2005 in press.

    Reime B, Klein MC, Kelly A, Duxbury N, Saxell L, Liston R, Prompers FJPM, Entjies RSW, Wong V. Do maternity care provider groups have different attitudes toward birth? BJOC—An International Journal of Obstetrics and Gynecology. 2004;111:1388-93

    Klein MC. Quick Fix Culture: The cesarean-section-on-demand debate. Guest editorial. Birth 2004;32(3): 161-4.

    Klein M, Johnston S, Christilaw J, Carty E Mothers, babies and communities. Centralizing maternity care exposes mothers and babies to complications and endangers community sustainability. Can Fam Physician 2002;48:1177-79.

    Klein MC. Use of episiotomy in the United States. (Letter). Birth 2002;29:74-75.

    Society of Rural Physicians of Canada, Society of Obstetricians and Gynaecologists of Canada, College of Family Physicians of Canada. Number of births to maintain competence. Can J Rural Med 2002;7:84-85.

    Klein MC, Kelly A, Spence A, Kaczorowski J, Grzybowski S. In for the Long Haul: why do family physicians plan to continue or discontinue intrapartum maternity care? Can Fam Physician 2002;48:1216-22.

    Klein MC, Spence A, Kelly A, Kaczorowski J. Does delivery volume of family physicians predict maternal and newborn outcome? CMAJ 2002;166(10):1257-1264.

    Janssen P, Lee S, Ryan E, Etches D, Farquharson D, Peacock D, Klein M Outcomes of Home vs Hospital-Intended Birth after Regulation of Midwifery in British Columbia.. CMAJ, 166(3):315-23, Feb 2002.

    Klein MC, Grzybowski S, Harris S, Liston R, Spence A, Le G, Brummendorf D, Kim S, Kaczorowski J. Epidural analgesia use as a marker for physician approach to birth: implications for maternal and newborn outcomes. Birth 28(4): 243-8; December 2001.

    Janssen P, Harris S, Soolsma J, Klein MC, Seymour L. Single Room Maternity Care: The Nursing Response. Birth 28:3 September 2001.

    Honours & Awards

    Award of Excellence: Family Physician Researcher of the Year, College of Family Physicians of Canada - November 2013

    Family Physician Researcher of the Year Award 2004, College of Family Physicians of Canada . “The award recognizes a family medicine researcher who has made original contributions to research and has been a pivotal force in the definition, development and dissemination of concepts central to the discipline of Family Medicine in Canada ."

    Maurice Wood Award for Lifetime Contributions to Primary Care Research, NAPCRG (The North American Primary Care Research Group) – October 2003

    Chair, Maternity and Newborn Care Committee of the College of Family Physicians of Canada – 1995-2002

    Society of Rural Physicians of Canada, Honorary Rural Physician award – May 1998
    Outstanding Contributions and Service to the growth of Family Medicine, The Society of Teachers of Family Medicine – April 1998

    The 1994 Society of Teachers of Family Medicine Best Research Paper Award – 1994

    The Dr. Michael Klein Fellowship in Maternal and Infant Care in Family Medicine was established at the Department of Family Medicine and The SMBD Jewish General Hospital in Montreal , in honour of efforts in involving family physicians in family centred maternal and infant care – 1992

    The Donald I. Rice Merit Award, College of Family Physicians of Canada – 1991

    Research Group Members
    • Dr. Rob Liston, Dr. Peter von Dadelszen, Lee Saxell (midwifery), Wendy Hall (nursing), Kathy Lindstrom (doula research) – collaborators in attitude research, pelvic floor issues
    • Christine Miewald, SFU Centre for Sustainable Community Development
    • Stefan Grzybowski and Jude Kornelsen – Co-PIs for an CIHR Emerging Team Grant on Rural Maternity Care.