What is a Cesarean Section?
A caesarean section (cesarean section AE), or C-section, is a form of childbirth in which a surgical incision is made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. It is usually performed when a vaginal delivery would lead to medical complications.
There are several elements which contribute to a linguistic
explanation of the word caesarean.The term may be simply derived from
the Latin verb caedere (supine stem caesum), 'to cut'. The term caesarean
section then would be a tautology.
There are several types of caesarean sections
Obstetricians or other care-providers 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) (dystocia);
apparent fetal distress; apparent maternal distress or omplications
such as pre-eclampsia, eclampsia; multiple births; abnormal presentation,
i.e.breech presentation; failed induction of labour; failed instrumental
delivery; the baby is too large (macrosomia); the mother has a low-lying
placenta or placenta praevia; contracted pelvis; evidence of intrauterine
infection; previous caesarean section (though this is controversial
– see below); prior problems with healing of the perineum, such
as from childbirth or Crohn's Disease.
Babies born by Caesarean often have some initial trouble breathing. In addition, because the baby will be drowsy from the pain medication administered to the mother, and because the mother's mobility is reduced, breast-feeding may be difficult.
A Caesarean section is a major operation, with all that it entails. Pain at the incision can be intense, and full recovery of mobility can take several weeks or more.
A prior Caesarean section increases the risk of uterine rupture during subsequent labour.
Concerns have been raised in recent years that the procedure is frequently performed for reasons other than medical necessity. While many obstetricians report cesarean rates over 30%, traditional midwives regularly report a cesarean rate lower than 10%, with a decreased risk of maternal and infant morbidity and no increase in mortality (Gaskin 2003).
Critics worry that caesareans are performed because they are profitable for the hospital, or because a quick caesarian is more convenient for an obstetrician than a lengthy vaginal birth. Another contribution factor may be fear of medical malpractice lawsuits. For example, the failure to perform a c-section became the core of numerous lawsuits against obstetricians over incidents of cerebral palsy.
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.
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
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.
The first recorded incidence of a woman surviving a caesarean section was in the Holy Roman Empire in 1500: Jacob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labor. For most of the time, the procedure had a high mortality. In Great Britain and Ireland the mortality in 1865 was 85%. Key steps in reducing mortality were:
Adherence to principles of asepsis .
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.
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