Caesarean section is the delivery of a baby through an incision in the mother’s abdomen and uterus. Most historians believe the name has no association with the birth of Julius Caesar. The operation was used centuries before his time in an effort to save unborn babies whose mothers had died during labour. The Roman law governing the procedure was known as Lex Regia, later changed to Lex Caesaria
(the Caesar’s Law) and this is thought to be the origin of the modern name.
Before the Second World War caesarean section was used only as a desperate last resort because of its high complication rate. One hundred years ago, more than nine out of ten mothers died after the operation: now the death rate is one to two in 10000, and usually occurs in mothers for whom it is performed because they are too ill for labour. Since 1940 improvements in surgical and anaesthetic techniques and the availability of antibiotics and blood transfusion have made caesarean section a safer option in circumstances where mother and baby would be at risk from a difficult vaginal delivery.
During the 1980s there was some controversy about the increasing rate of caesarean delivery: up to four out of ten deliveries in some parts of the USA. In Australia the present rate is close to one in five deliveries, and there has been public and professional concern about whether so many caesarean deliveries, with their accompanying physical, psychological and financial costs, are justified. Are some doctors (and parents) choosing caesarean delivery rather than waiting to see if vaginal delivery can proceed safely? It’s impossible to answer this question because the circumstances in every case are different. If you’re advised to have a caesarean delivery, whatever you’ve heard about the controversy may raise doubts in your mind. You must discuss your uncertainties with your doctor.
Elective caesarean section
About half of all problems that need caesarean section are discovered during pregnancy so that the operation can be planned. This is called elective caesarean section. Common reasons include:
• placenta praevia, where the placenta is attached over the cervical outlet and would lead to severe haemorrhage during labour
• previous caesarean delivery, where the reasons for doing it still exist
• some cases of breech presentation, especially if the mother’s pelvis is smaller than average, if the mother is over 35, or if it is the first delivery
• severe pregnancy-induced hypertension
• some cases of diabetes or Rhesus incompatibility, when vaginal delivery can’t be risked
• rarely, when there is obstruction in the pelvis, such as a fibroid, or if there is certain knowledge that the mother’s pelvic outlet is too narrow to allow the baby’s head to pass through.
If caesarean section is elective, your doctor will explain why and how it will be done. You should discuss with your doctor whether you’ll have it done with epidural block (which means that you’re awake and see and hold your baby the moment it’s delivered, and that your partner can be present for the delivery if you both wish) or general anaesthetic.
Emergency caesarean section
This is done when problems arise during labour, such as:
• foetal distress due to lack of oxygen in the first stage, indicated by change the foetal heart rate. If allowed to go for long, lack of oxygen could lea foetal brain damage or death
• haemorrhage during the first stage labour
• obstructed labour
• failure of labour to progress because cervix is not dilating.
Emergency caesarean section is often d with general anaesthetic when the needs to be delivered as quickly possible.
Maternal recovery is usually slower caesarean than after vaginal delivery, though there may be some delay mother-child bonding if a general anaesthetic is needed, there’s no evidence this has any bad effect on the long-term relationship.
Many women are sadly disappointed their baby must be delivered by caesarean, especially if it is done as an emergency and they don’t have time to adjust to the idea. Of course we would all prefer to have normal deliveries, but some babies need to be helped into the world and no one wants to take any risks. In many pregnancies caesarean delivery can be life-saving for both mother and baby, or can prevent serious illness.
You may have heard ‘once a caesarean, always a caesarean’. With modern surgical techniques, this is not necessarily true. Many mothers who have had a previous caesarean delivery may safely have a subsequent vaginal delivery, provided the reason for caesarean no longer exists or doesn’t recur in the next pregnancy. Ask your doctor about your future chance of vaginal delivery.
The most important result of pregnancy is a healthy outcome. Without the safety of modem caesarean delivery we would have to accept a higher rate of foetal and maternal loss, as our grandparents did. So don’t feel a failure if you need caesarean delivery: if a healthy baby is delivered, your pregnancy has been a success.
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