Caesarean section

A Caesarean section (spelled Cesarean section in American English), commonly called a c-section, is a surgical procedure by which one or more babies are delivered through an incision into the mother's abdomen and uterus. The mother usually receives spinal or epidural anesthesia, which allows her to remain awake for the delivery and does not sedate the unborn child. In cases of emergency, general anesthesia is usually used because it is faster.

This procedure is often employed as an alternative to traditional, vaginal delivery when that might pose a risk to the mother or baby. Possible reasons given for Caesarean delivery include a prolonged labour (failure to progress), apparent fetal distress, multiple births, and breech presentation. The incidence of Caesarean sections increases among women who have received fertility drugs which often cause the mother to carry several offspring simultaneously.

Increased need for Caesarean section may be caused by higher maternal age, use of epidural analgesia for pain relief, a large fetus, maternal obesity, previous Caesarean, pre-eclampsia and eclampsia.

In the US, somewhat less than one woman in 2,500 who has a Caesarian section will die, compared to a rate of one in 10,000 for a vaginal delivery.[1] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth. [1] The mortality rates of vaginal and Caesarean deliveries cannot be directly compared, as births in which the surgery is indicated carry a higher risk of mortaility in and of themselves.

Table of contents

1 Rates C-Sections Against Total Births
2 VBAC
3 Name History

Rates C-Sections Against Total Births

The World Health Organisation puts the acceptable rate of caesarian sections at between 10% and 15% of all births in developed countries. In the UK about 20% of all births are caesarian, with significant regional variation, from 13% in the county of Cornwall to 26% in Surrey and up to almost 50% in local areas. [1] In the French Sentinele Network the rate is about 15%. [1] In 2003, the Canadian C-section rate was 21%, with regional variations: 28% of New Brunswick babies in that year were born by C-section.[1]. In the United States, some 23% of all babies are born by C-section.[1]

Concerns have been raised in recent years, that the procedure is frequently being used in the US for reasons other than medical necessity. Organizations have been formed to make the public aware of Caesarean operations and their dramatically increased incidence. Attendance by a midwife and out-of-hospital labor are associated with much lower rates of Caesarean section, when controlled for all relevant maternal and fetal indicators.

VBAC

Vaginal birth after Caesareans ("VBAC") are now quite common. In the past, Caesarean sections used a vertical incision cutting the uterine muscle fibers. Current Caesareans typically use a hortizontal incision cutting along the muscle fibers. The uterus maintains its integerity and can tolerate the strong contractions of childbirth. Cosmetically the scar for modern Caesareans is below the bikini line and is sometimes called the "bikini cut".

Obstetricians differ on the relative merits of vaginal and cesarian birth following a cesarean birth. Some still recommend a cesarian routinely, others do not; still others respect the wishes of the expectant mother.

Name History

Caesarean sections are so-named because, according to folklore, this is the method by which the Roman dictator Julius Caesar was delivered. However there is evidence that his mother was still alive when he was an adult, and given that at the time the procedure would have almost certainly resulted in the death of the mother, it is more likely that it is so named because it first came into use in the time of Caesar. The ancient Romans did have a law called Lex Caesare literally "to cut". A dying woman in the latter stages of pregnancy would have a baby removed before she died on her own.

The first recorded incidence of a woman surviving a Caesarean section dates from Germany in 1500: Jacob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labor.

C-sections also appear in Shakespeare's play MacBeth. MacBeth faces a prophesized enemy not of woman-born, an impossibility but that MacDuff was "from his mother's womb untimely ripp'd," the product of a C-section birth.