Caesarean section

Caesarean section
A team of five performing a caesarean section[1]
Other names	C-section, caesarean section, caesarean delivery
Specialty	Obstetrics, gynaecology, surgery, neonatology, pediatrics, family medicine
ICD-10-PCS	10D00Z0
ICD-9-CM	74
MeSH	D002585
MedlinePlus	002911
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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]