Online Encyclopedia
Caesarean section
A Caesarean section (Cesarean section AE), is a surgical procedure to deliver one or more babies through an incision in the mother's abdomen and uterus.
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Indications
Obstetricians recommend caesarean section when vaginal delivery might pose a risk to the mother or baby. Possible reasons for Caesarean delivery include:
- prolonged labour (or failure to progress )
- apparent fetal distress
- multiple births
- breech presentation
Risks
Old statistics say that less than one woman in 2,500 who has a caesarean section will die, compared to a rate of one in 10,000 for a vaginal delivery.[1]. However the mortality rate for both is now much much lower than that as it has been dropping steadily. The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth. [2] It is not possible to directly compare the mortality rates of vaginal and caesarean deliveries as women having the surgery are known to be at higher risk.
Caesarean section rates
The prevalence of caesarean sections increases among women who:
- have received fertility drugs which may cause the mother to carry several offspring simultaneously
- are older
- have a large fetus
- are obese
- have had a previous caesarean
- are suffering from pre-eclampsia or eclampsia
- others
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. [3] In the French Sentinele Network the rate is about 15%. [4] In 2003, the Canadian caesarian section rate was 21%, with regional variations: 28% of New Brunswick babies in that year were born by caesarian section.[5]. In the United States, some 23% of all babies are born by caesarian section.[6]
Concerns have been raised in recent years that the procedure is frequently performed for reasons other than medical necessity. Organisations 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.
Anaesthesia
The mother usually receives regional anaesthesia (spinal or epidural), allowing her to remain awake for the delivery and avoiding sedation of the infant.
In modern practice, general anesthesia for caesarean section is becoming increasingly rare as scientific research has now clearly established the benefits of regional aneasthesia for both the mother and baby.
Vaginal births after caesarean
Vaginal births after caesarean ("VBAC") are now common. In the past, caesarean sections used a vertical incision which cut the uterine muscle fibers. Modern caesareans typically involve a horizontal incision along the muscle fibers. The uterus then better maintains its integrity and can tolerate the strong contractions of future childbirth. Cosmetically the scar for modern caesareans is below the "bikini line".
Obstetricians differ on the relative merits of vaginal and caesarian birth following a caesarean birth. Some still recommend a caesarian routinely, others do not; still others respect the wishes of the expectant mother.
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. There is also evidence, however, that Caesar had Marfan Syndrome, an inherited disease that can cause death during childbirth. If his mother had Marfan's, he may have been cut from her dying body. 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 was in Germany in 1500: Jacob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labor.
On March 5, 2000, Ines Ramirez performed a caesarean section on herself and survived, as did her son, Orlando Ruiz Ramirez. She is believed to be the only woman to have performed a successful caesarean section on herself. [7]
Fictional
Caesarean 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 caesarean section birth.
The stillborn child of character Catherine Barkley is delivered by caesarean section in the Hemingway novel A Farewell to Arms.
External links
Caesareans and VBACs FAQ: a private research site