Caesarean section

Caesarean section Delivery of a baby by the surgical incision of the mother's abdominal wall and uterus has a long history although it is only in the last century that the procedure of Caesarean section has carried any realistic expectation of maternal survival. The origin of the name ‘Caesarean’ is obscure. Although it is commonly linked to Julius Caesar, his mother is known to have been alive at the time of the invasion of Britain by his Roman army. It is highly unlikely that she would have survived delivery by ‘section’. Some have suggested that the term is derived instead from the Latin verb ‘to cut’, caedare.

Many early Caesarean sections were performed post-mortem as attempts to ensure survival of the baby after death of the mother. This may have been the case with MacDuff, who caused the downfall of Shakespeare's Scottish king, Macbeth, and who was ‘from his mother's womb, untimely ript’. Caesarean sections were performed sporadically during the seventeenth, eighteenth, and nineteenth centuries as deliberate surgical procedures on living women with obstructed labour, although survival was rare. During the twentieth century, improvements in anaesthesia and the availability of antibiotics and blood transfusion made the operation increasingly less hazardous. It is now commonplace for the mother to be awake during Caesarean section, but pain-free as a result of epidural or spinal anaesthesia.

Caesarean section may be performed as a planned (‘elective’) or an emergency procedure. Reasons for elective operations include breech presentation (a controversial issue), placenta praevia (in which the placenta is below the baby and would bleed during labour), or previous Caesarean sections for recurring complications. Emergency operations are mainly performed for ‘fetal distress’, or for ‘failure to progress’ during labour. The main causes of failed progress are poor contractions of the uterus, a baby too large to be accommodated by the mother's pelvis, or an occipito-posterior position (the baby's head facing away from the mother's spine).

Caesarean section is almost always, now, performed as the ‘lower segment’ operation, which produces a wound in the womb that heals well and which will be strong enough usually to cope with future labours. The formerly favoured ‘classical’ operation produced a wound that was, in contrast, prone to falling apart in subsequent pregnancies.

J. Neilson

See also birth; labour; pregnancy.