Caesarean section

Caesarean section
A team of five performing a caesarean section[1]
Other namesC-section, caesarean section, caesarean delivery
SpecialtyObstetrics, gynaecology, surgery, neonatology, pediatrics, family medicine
ICD-10-PCS10D00Z0
ICD-9-CM74
MeSHD002585
MedlinePlus002911

Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would put the mother or child at risk.[2] Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord.[2][3] A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section.[2][3] A trial of vaginal birth after C-section may be possible.[2] The World Health Organization recommends that caesarean section be performed only when medically necessary.[3][4]

A C-section typically takes 45 minutes to an hour.[2] It may be done with a spinal block, where the woman is awake, or under general anesthesia.[2] A urinary catheter is used to drain the bladder, and the skin of the abdomen is then cleaned with an antiseptic.[2] An incision of about 15 cm (6 inches) is then typically made through the mother's lower abdomen.[2] The uterus is then opened with a second incision and the baby delivered.[2] The incisions are then stitched closed.[2] A woman can typically begin breastfeeding as soon as she is out of the operating room and awake.[5] Often, several days are required in the hospital to recover sufficiently to return home.[2]

C-sections result in a small overall increase in poor outcomes in low-risk pregnancies.[3] They also typically take about six weeks to heal from, longer than vaginal birth.[2] The increased risks include breathing problems in the baby and amniotic fluid embolism and postpartum bleeding in the mother.[3] Established guidelines recommend that caesarean sections not be used before 39 weeks of pregnancy without a medical reason.[6] The method of delivery does not appear to have an effect on subsequent sexual function.[7]

In 2012, about 23 million C-sections were done globally.[8] The international healthcare community has previously considered the rate of 10% and 15% to be ideal for caesarean sections.[4] Some evidence finds a higher rate of 19% may result in better outcomes.[8] More than 45 countries globally have C-section rates less than 7.5%, while more than 50 have rates greater than 27%.[8] Efforts are being made to both improve access to and reduce the use of C-section.[8] In the United States as of 2017, about 32% of deliveries are by C-section.[9] The surgery has been performed at least as far back as 715 BC following the death of the mother, with the baby occasionally surviving.[10] A popular idea is that the Roman statesman Julius Caesar was born via caesarean section and is the namesake of the procedure, but if this is the true etymology, it is based on a misconception: until the modern era, C-sections seem to have been invariably fatal to the mother, and Caesar's mother Aurelia not only survived her son's birth but lived for nearly 50 years afterward.[11][12] There are many ancient and medieval legends, oral histories, and historical records of laws about C-sections around the world, especially in Europe, the Middle East and Asia.[13][14] The first recorded successful C-section (where both the mother and the infant survived) was performed on a woman in Switzerland in 1500 by her husband, Jakob Nufer, though this was not recorded until 8 decades later.[13] With the introduction of antiseptics and anesthetics in the 19th century, survival of both the mother and baby, and thus the procedure, became significantly more common.[10][15]

  1. ^ Fadhley S (2014). "Caesarean section photography". WikiJournal of Medicine. 1 (2). doi:10.15347/wjm/2014.006.
  2. ^ a b c d e f g h i j k l "Pregnancy Labor and Birth". Office on Women's Health, U.S. Department of Health and Human Services. 1 February 2017. Archived from the original on 28 July 2017. Retrieved 15 July 2017.Public Domain This article incorporates text from this source, which is in the public domain.
  3. ^ a b c d e "Safe Prevention of the Primary Cesarean Delivery". American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. March 2014. Retrieved 23 January 2022.
  4. ^ a b "WHO Statement on Caesarean Section Rates" (PDF). 2015. Archived (PDF) from the original on 1 May 2015. Retrieved 6 May 2015.
  5. ^ Lauwers J, Swisher A (2010). "Hospital Practices that Support Breast Feeding". Counseling the Nursing Mother: A Lactation Consultant's Guide. Jones & Bartlett Publishers. p. 274. ISBN 978-1-4496-1948-0. Archived from the original on 11 September 2017.
  6. ^ American Congress of Obstetricians and Gynecologists, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Congress of Obstetricians and Gynecologists, archived from the original on 1 September 2013, retrieved 1 August 2013
  7. ^ Yeniel AO, Petri E (January 2014). "Pregnancy, childbirth, and sexual function: perceptions and facts". International Urogynecology Journal. 25 (1): 5–14. doi:10.1007/s00192-013-2118-7. PMID 23812577. S2CID 2638969.
  8. ^ a b c d Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. (December 2015). "Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality". JAMA. 314 (21): 2263–2270. doi:10.1001/jama.2015.15553. PMID 26624825.
  9. ^ "Births: Provisional Data for 2017" (PDF). CDC. May 2018. Archived (PDF) from the original on 17 May 2018. Retrieved 18 May 2018.
  10. ^ a b Moore MC, de Costa C (2004). "A Brief History of Cesarean Section". Cesarean Section: Understanding and Celebrating Your Baby's Birth. JHU Press. p. 31. ISBN 978-0-8018-8133-6.
  11. ^ Meehan FP (January 1988). "Caesarean section-past, present and what of the future?". Journal of Obstetrics and Gynaecology. 8 (3): 201–205. doi:10.3109/01443618809012284. ISSN 0144-3615.
  12. ^ "Cesarean Section - A Brief History preface". www.nlm.nih.gov. Retrieved 14 March 2024.
  13. ^ a b Dhakal-Rai S, van Teijlingen E, Regmi P, Wood J, Dangal G, Dhakal KB (10 October 2021). "A brief history and indications for cesarean section". Journal of Patan Academy of Health Sciences. 8 (3): e1–e10. doi:10.3126/jpahs.v8i3.27657. ISSN 2091-2749.
  14. ^ Hillan EM (October 1991). "Caesarean Section: Historical Background". Scottish Medical Journal. 36 (5): 150–154. doi:10.1177/003693309103600511. ISSN 0036-9330. PMID 1788548.
  15. ^ "The Truth About Julius Caesar and "Caesarean" Sections". 25 October 2013.