Caesarean section
Overview
A Caesarean section, is a surgical
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 procedure in which one or more incisions are made through a mother's abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...

 (laparotomy
Laparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...

) and uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...

 (hysterotomy
Hysterotomy
A hysterotomy is an incision in the uterus, commonly combined with a laparotomy during a caesarean section. Hysterotomies are also performed during fetal surgery....

) to deliver
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

 one or more babies
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...

, or, rarely, to remove a dead fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...

. A late-term abortion
Late-term abortion
Late termination of pregnancy or late-term abortions are abortions which are performed during a later stage of pregnancy. Late-term abortions are more controversial than abortion in general because the fetus is more developed and sometimes viable.-Definition:A late-term abortion often refers to an...

 using Caesarean section procedures is termed a hysterotomy abortion
Hysterotomy abortion
Hysterotomy abortion is a form of abortion in which the uterus is opened through an abdominal incision and the fetus is removed, similar to a caesarean section, but requiring a smaller incision...

 and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer
Ferdinand Adolf Kehrer
Ferdinand Adolf Kehrer was a German gynecologist who was a native of Guntersblum in Rhenish Hesse. He was the father of neurologist Ferdinand Adalbert Kehrer ....

 in 1881.

A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been also performed upon request
Caesarean delivery on maternal request
Caesarean delivery on maternal request is a medically unnecessary caesarean section, where the conduct of a childbirth via a caesarean section is requested by the pregnant patient...

 for childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

s that could otherwise have been natural.
Encyclopedia
A Caesarean section, is a surgical
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 procedure in which one or more incisions are made through a mother's abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...

 (laparotomy
Laparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...

) and uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...

 (hysterotomy
Hysterotomy
A hysterotomy is an incision in the uterus, commonly combined with a laparotomy during a caesarean section. Hysterotomies are also performed during fetal surgery....

) to deliver
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

 one or more babies
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...

, or, rarely, to remove a dead fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...

. A late-term abortion
Late-term abortion
Late termination of pregnancy or late-term abortions are abortions which are performed during a later stage of pregnancy. Late-term abortions are more controversial than abortion in general because the fetus is more developed and sometimes viable.-Definition:A late-term abortion often refers to an...

 using Caesarean section procedures is termed a hysterotomy abortion
Hysterotomy abortion
Hysterotomy abortion is a form of abortion in which the uterus is opened through an abdominal incision and the fetus is removed, similar to a caesarean section, but requiring a smaller incision...

 and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer
Ferdinand Adolf Kehrer
Ferdinand Adolf Kehrer was a German gynecologist who was a native of Guntersblum in Rhenish Hesse. He was the father of neurologist Ferdinand Adalbert Kehrer ....

 in 1881.

A Caesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been also performed upon request
Caesarean delivery on maternal request
Caesarean delivery on maternal request is a medically unnecessary caesarean section, where the conduct of a childbirth via a caesarean section is requested by the pregnant patient...

 for childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

s that could otherwise have been natural. In recent years the rate has risen to a record level of 46% in China and to levels of 25% and above in many Asian and European countries, Latin America, and the United States.

Etymology

The Roman Lex Regia, (later the Lex Caesarea) of Numa Pompilius
Numa Pompilius
Numa Pompilius was the legendary second king of Rome, succeeding Romulus. What tales are descended to us about him come from Valerius Antias, an author from the early part of the 1st century BC known through limited mentions of later authors , Dionysius of Halicarnassus circa 60BC-...

 (715–673 BC), required that the child of a mother dead in childbirth be cut from her womb.

This seems to have begun as a religious requirement that mothers not be buried pregnant,
and to have evolved into a way of saving the foetus, with Roman practice requiring a living mother be in her 10th month of pregnancy before the procedure was resorted to, reflecting the knowledge that she could not survive the delivery.
Rumours that the term refers to the birth of the Roman Dictator
Roman dictator
In the Roman Republic, the dictator , was an extraordinary magistrate with the absolute authority to perform tasks beyond the authority of the ordinary magistrate . The office of dictator was a legal innovation originally named Magister Populi , i.e...

 Julius Caesar
Julius Caesar
Gaius Julius Caesar was a Roman general and statesman and a distinguished writer of Latin prose. He played a critical role in the gradual transformation of the Roman Republic into the Roman Empire....

 are false; although Caesarean sections were performed in Roman
Ancient Rome
Ancient Rome was a thriving civilization that grew on the Italian Peninsula as early as the 8th century BC. Located along the Mediterranean Sea and centered on the city of Rome, it expanded to one of the largest empires in the ancient world....

 times, no classical source records a mother surviving such a delivery, – the earliest recorded survival dates to 1500 AD – and Caesar's mother Aurelia Cotta
Aurelia Cotta
Aurelia Cotta or Aurelia was the mother of Roman dictator Gaius Julius Caesar .-Family:...

 lived to serve him as an advisor in his adulthood.

The term has also been explained as deriving from the verb caedere, 'to cut', with children delivered this way referred to as caesones. Pliny the Elder
Pliny the Elder
Gaius Plinius Secundus , better known as Pliny the Elder, was a Roman author, naturalist, and natural philosopher, as well as naval and army commander of the early Roman Empire, and personal friend of the emperor Vespasian...

 refers to a certain Julius Caesar (not the dictator, but a remote ancestor) as ab utero caeso, "cut from the womb", a godly attribute comparable to rumours about the birth of Alexander the Great. This and Caesar's name may have led to a false etymological connection with the ancient monarch. It should be noted that the Oxford English Dictionary does not credit a derivation from "caedere", and defines Caesarean birth as "the delivery of a child by cutting through the walls of the abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...

 when delivery cannot take place in the natural way, as was done in the case of Julius Cæsar".

Some link with Julius Caesar
Julius Caesar
Gaius Julius Caesar was a Roman general and statesman and a distinguished writer of Latin prose. He played a critical role in the gradual transformation of the Roman Republic into the Roman Empire....

, or with Roman Dictator
Roman dictator
In the Roman Republic, the dictator , was an extraordinary magistrate with the absolute authority to perform tasks beyond the authority of the ordinary magistrate . The office of dictator was a legal innovation originally named Magister Populi , i.e...

s generally, exists in other languages as well. For example, the modern German
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....

, Danish
Danish language
Danish is a North Germanic language spoken by around six million people, principally in the country of Denmark. It is also spoken by 50,000 Germans of Danish ethnicity in the northern parts of Schleswig-Holstein, Germany, where it holds the status of minority language...

, Dutch
Dutch language
Dutch is a West Germanic language and the native language of the majority of the population of the Netherlands, Belgium, and Suriname, the three member states of the Dutch Language Union. Most speakers live in the European Union, where it is a first language for about 23 million and a second...

 and Hungarian
Hungarian language
Hungarian is a Uralic language, part of the Ugric group. With some 14 million speakers, it is one of the most widely spoken non-Indo-European languages in Europe....

 terms are respectively Kaiserschnitt, kejsersnit, keizersnede, and császármetszés (literally: "Emperor's cut"). The German term has also been imported into Japanese
Japanese language
is a language spoken by over 130 million people in Japan and in Japanese emigrant communities. It is a member of the Japonic language family, which has a number of proposed relationships with other languages, none of which has gained wide acceptance among historical linguists .Japanese is an...

 (帝王切開 teiōsekkai) and Korean
Korean language
Korean is the official language of the country Korea, in both South and North. It is also one of the two official languages in the Yanbian Korean Autonomous Prefecture in People's Republic of China. There are about 78 million Korean speakers worldwide. In the 15th century, a national writing...

 (제왕 절개 jewang jeolgae), both literally meaning "emperor incision." Similar in Western Slavic (Polish) cięcie cesarskie, (Czech) císařský řez and (Slovak) cisársky rez (literally "imperial cut"), whereas the South Slavic term is Serbian
Serbian language
Serbian is a form of Serbo-Croatian, a South Slavic language, spoken by Serbs in Serbia, Bosnia and Herzegovina, Montenegro, Croatia and neighbouring countries....

 царски рез and Slovenian
Slovenian language
Slovene or Slovenian is a South Slavic language spoken by approximately 2.5 million speakers worldwide, the majority of whom live in Slovenia. It is the first language of about 1.85 million people and is one of the 23 official and working languages of the European Union...

 cárski réz, which literally means tzar cut. The Russian
Russian language
Russian is a Slavic language used primarily in Russia, Belarus, Uzbekistan, Kazakhstan, Tajikistan and Kyrgyzstan. It is an unofficial but widely spoken language in Ukraine, Moldova, Latvia, Turkmenistan and Estonia and, to a lesser extent, the other countries that were once constituent republics...

 term kesarevo secheniye (Кесарево сечение késarevo sečénije) literally means Caesar's section. The Arabic term (ولادة قيصرية wilaada qaySaríyya) also means pertaining to Caesar or literally Caesarean. The Hebrew
Hebrew language
Hebrew is a Semitic language of the Afroasiatic language family. Culturally, is it considered by Jews and other religious groups as the language of the Jewish people, though other Jewish languages had originated among diaspora Jews, and the Hebrew language is also used by non-Jewish groups, such...

 term ניתוח קיסרי (nitúakh Keisári) translates literally as Caesarean Surgery. In Romania
Romania
Romania is a country located at the crossroads of Central and Southeastern Europe, on the Lower Danube, within and outside the Carpathian arch, bordering on the Black Sea...

 and Portugal
Portugal
Portugal , officially the Portuguese Republic is a country situated in southwestern Europe on the Iberian Peninsula. Portugal is the westernmost country of Europe, and is bordered by the Atlantic Ocean to the West and South and by Spain to the North and East. The Atlantic archipelagos of the...

 it is usually called cesariana, meaning from (or related to) Caesar
Caesar (title)
Caesar is a title of imperial character. It derives from the cognomen of Julius Caesar, the Roman dictator...

. According to Shahnameh
Shahnameh
The Shahnameh or Shah-nama is a long epic poem written by the Persian poet Ferdowsi between c.977 and 1010 AD and is the national epic of Iran and related societies...

 ancient Persian book, the hero Rostam
Rostam
Rostam is the national hero of Greater Iran from Zabulistan in Persian mythology and son of Zal and Rudaba. In some ways, the position of Rostam in the historical tradition is parallel to that of Surena, the hero of the Carrhae. His figure was endowed with many features of the historical...

 was the first person who was born with this method and term رستمينه (rostamineh) is corresponded to Caesarean.

Finally, the Roman praenomen
Praenomen
The praenomen was a personal name chosen by the parents of a Roman child. It was first bestowed on the dies lustricus , the eighth day after the birth of a girl, or the ninth day after the birth of a boy...

 (given name) Caeso
Caeso (praenomen)
Caeso or Kaeso is a Latin praenomen, or personal name, usually abbreviated K. Although never a common name, Caeso was regularly used by a number of prominent families, both patrician and plebeian, during the period of the Roman Republic. The feminine form is Caesula...

 was said to be given to children who were born via c-section. While this was probably just folk etymology made popular by Pliny the Elder, it was well known by the time the term came into common use.

Orthography

  • The e/ae/æ variation reflects American and British English spelling differences
    American and British English spelling differences
    One of the ways in which American English and British English differ is in spelling.-Historical origins:In the early 18th century, English spelling was not standardized. Differences became noticeable after the publishing of influential dictionaries...

    .
  • The cap-versus-lowercase variation reflects a style of lowercasing some eponymous terms (e.g., cesarean, eustachian, fallopian, mendelian, parkinsonian, parkinsonism
    Parkinsonism
    Parkinsonism is a neurological syndrome characterized by tremor, hypokinesia, rigidity, and postural instability. The underlying causes of parkinsonism are numerous, and diagnosis can be complex...

    ). Cap and lowercase stylings coexist in prevalent usage. Intradocument style consistency is usually advocated.

History

Bindusara
Bindusara
Bindusara was the second Mauryan emperor after Chandragupta Maurya. During his reign, the empire expanded southwards. He had two well-known sons, Susima and Ashoka, who were the viceroys of Taxila and Ujjain...

 (Born c. 320 BC, ruled: 298 – c.272 BC), the second Mauryan Samrat (emperor) of India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

 (after Chandragupta Maurya
Chandragupta Maurya
Chandragupta Maurya , was the founder of the Maurya Empire. Chandragupta succeeded in conquering most of the Indian subcontinent. Chandragupta is considered the first unifier of India and its first genuine emperor...

 the Great), is said to be the first child born by surgery. His mother, wife of Chandragupta Maurya, accidentally consumed poison and died when she was close to delivering him. Chanakya
Chanakya
Chānakya was a teacher to the first Maurya Emperor Chandragupta , and the first Indian emperor generally considered to be the architect of his rise to power. Traditionally, Chanakya is also identified by the names Kautilya and VishnuGupta, who authored the ancient Indian political treatise...

, the Chandragupta's teacher and advisor, made up his mind that the baby should survive. He cut open the belly of the queen and took out the baby, thus saving the baby's life.

In the Irish Mythological
Irish mythology
The mythology of pre-Christian Ireland did not entirely survive the conversion to Christianity, but much of it was preserved, shorn of its religious meanings, in medieval Irish literature, which represents the most extensive and best preserved of all the branch and the Historical Cycle. There are...

 text the Ulster Cycle
Ulster Cycle
The Ulster Cycle , formerly known as the Red Branch Cycle, one of the four great cycles of Irish mythology, is a body of medieval Irish heroic legends and sagas of the traditional heroes of the Ulaid in what is now eastern Ulster and northern Leinster, particularly counties Armagh, Down and...

, the character Furbaide Ferbend
Furbaide Ferbend
Furbaide Ferbend is a character from the Ulster Cycle of Irish mythology. His father is Conchobar mac Nessa, king of the Ulaid. His mother is one of the daughters of Eochu Feidlech, the High King of Ireland: in the saga Cath Boinde and the Dindsenchas poem "Carn Furbaide" she is Eithne, in the...

 is said to have been born by posthumous Caesarean section, after his mother was murdered by his evil aunt Medb
Medb
Medb – Middle Irish: Meḋḃ, Meaḋḃ; early modern Irish: Meadhbh ; reformed modern Irish Méabh, Medbh; sometimes Anglicised Maeve, Maev or Maive – is queen of Connacht in the Ulster Cycle of Irish mythology...

.

The Balylonian Talmud, an ancient Jewish religious text, mentions a procedure similar to the Caesarian section. The procedure is termed "yotzei dofen".

Pliny the Elder
Pliny the Elder
Gaius Plinius Secundus , better known as Pliny the Elder, was a Roman author, naturalist, and natural philosopher, as well as naval and army commander of the early Roman Empire, and personal friend of the emperor Vespasian...

 theorized that Julius Caesar's name came from an ancestor who was born by Caesarean section, but the truth of this is debated (see the article on the Etymology of the name of Julius Caesar
Etymology of the name of Julius Caesar
The name Caesar probably originated from a dialect of Latium which did not share the rhotacism of the Roman dialect. Using the Latin alphabet as it existed in the day of Julius Caesar , Caesar's name is properly rendered GAIVS IVLIVS CAESAR The name Caesar probably originated from a dialect of...

). The Ancient Roman Caesarean section was first performed to remove a baby from the womb of a mother who died during childbirth. Caesar's mother, Aurelia
Aurelia Cotta
Aurelia Cotta or Aurelia was the mother of Roman dictator Gaius Julius Caesar .-Family:...

, lived through childbirth and successfully gave birth to her son, ruling out the possibility that the Roman Dictator and General was born by Caesarean section.
The Catalan
Catalonia
Catalonia is an autonomous community in northeastern Spain, with the official status of a "nationality" of Spain. Catalonia comprises four provinces: Barcelona, Girona, Lleida, and Tarragona. Its capital and largest city is Barcelona. Catalonia covers an area of 32,114 km² and has an...

 saint Raymond Nonnatus
Raymond Nonnatus
Saint Raymond Nonnatus was a saint from Catalonia in Spain. His surname refers to his birth by Caesarean section...

 (1204–1240), received his surname—from the Latin
Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...

 non natus ("not born")—because he was born by Caesarean section. His mother died while giving birth to him.

In 1316 the future Robert II of Scotland
Robert II of Scotland
Robert II became King of Scots in 1371 as the first monarch of the House of Stewart. He was the son of Walter Stewart, hereditary High Steward of Scotland and of Marjorie Bruce, daughter of Robert I and of his first wife Isabella of Mar...

 was delivered by Caesarean section—his mother, Marjorie Bruce
Marjorie Bruce
Marjorie Bruce or Marjorie de Brus was the eldest daughter of Robert the Bruce, King of Scots by his first wife, Isabella of Mar, and the founder of the Stewart dynasty. Her marriage to Walter, High Steward of Scotland gave rise to the House of Stewart...

, died. This may have been the inspiration for Macduff
Macduff (thane)
Macduff, the Thane of Fife, is a character in William Shakespeare's Macbeth . Macduff plays a pivotal role in the play: he suspects Macbeth of regicide and eventually kills Macbeth in the final act...

 in Shakespeare's play Macbeth
Macbeth
The Tragedy of Macbeth is a play by William Shakespeare about a regicide and its aftermath. It is Shakespeare's shortest tragedy and is believed to have been written sometime between 1603 and 1607...

".).

Caesarean section usually resulted in the death of the mother; the first recorded incidence of a woman surviving a Caesarean section was in the 1580s, in Siegershausen
Kemmental
Kemmental is a municipality in the district of Kreuzlingen in the canton of Thurgau in Switzerland.The municipality was formed on 1 January 1996 through the merger of Alterswilen, Hugelshofen, Altishausen, Dotnacht, Ellighausen, Lippoldswilen, Neuwilen and Siegershausen.-History:Each of the former...

, Switzerland: Jakob Nufer
Jakob Nufer
Jakob Nufer was a Swiss pig-gelder who, around 1500, reportedly performed the first successful Caesarean section in history in which the mother survived....

, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labour. However, there is some basis for supposing that women regularly survived the operation in Roman times. For most of the time since the sixteenth century, the procedure had a high mortality
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....

 rate. However, it was long considered an extreme measure, performed only when the mother was already dead or considered to be beyond help. In Great Britain and Ireland the mortality rate in 1865 was 85%. Key steps in reducing mortality were:
  • Introduction of the transverse incision technique to minimize bleeding by Ferdinand Adolf Kehrer
    Ferdinand Adolf Kehrer
    Ferdinand Adolf Kehrer was a German gynecologist who was a native of Guntersblum in Rhenish Hesse. He was the father of neurologist Ferdinand Adalbert Kehrer ....

     in 1881. This is thought to be first modern CS performed.
  • The introduction of uterine suturing by Max Sänger
    Max Saenger
    Max Saenger was a German obstetrician and gynecologist who was a native of Bayreuth.He studied medicine at the University of Leipzig, and continued his graduate studies in OB/GYN and pathology under Carl Siegmund Franz Credé...

     in 1882.
  • Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912).
  • Adherence to principles of asepsis
    Asepsis
    Asepsis is the state of being free from disease-causing contaminants or, preventing contact with microorganisms. The term asepsis often refers to those practices used to promote or induce asepsis in an operative field in surgery or medicine to prevent infection...

    .
  • Anesthesia
    Anesthesia
    Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

     advances.
  • Blood transfusion
    Blood transfusion
    Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...

    .
  • Antibiotic
    Antibiotic
    An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...

    s.


European travelers in the Great Lakes region of Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...

 during the 19th century observed Caesarean sections being performed on a regular basis. The expectant mother was normally anesthetized with alcohol, and herbal mixtures were used to encourage healing. From the well-developed nature of the procedures employed, European observers concluded that they had been employed for some time.

The first successful Caesarean section to be performed in America took place in what was formerly Mason County Virginia (now Mason County West Virginia) in 1794. The procedure was performed by Dr. Jesse Bennett on his wife Elizabeth.

On March 5, 2000, Inés Ramírez
Inés Ramírez
Inés Ramírez Pérez is a Mexican woman from the state of Oaxaca who gained media attention after performing a successful Caesarean section on herself in 2000, making her the only person known to have done so successfully.-History:...

 performed a Caesarean section on herself and survived, as did her son, Orlando Ruiz Ramírez. She is believed to be the only woman to have performed a successful Caesarean section on herself.

An early account of Caesarean section in Iran
Iran
Iran , officially the Islamic Republic of Iran , is a country in Southern and Western Asia. The name "Iran" has been in use natively since the Sassanian era and came into use internationally in 1935, before which the country was known to the Western world as Persia...

 is mentioned in the book of Shahnameh
Shahnameh
The Shahnameh or Shah-nama is a long epic poem written by the Persian poet Ferdowsi between c.977 and 1010 AD and is the national epic of Iran and related societies...

, written around 1000 AD, and relates to the birth of Rostam
Rostam
Rostam is the national hero of Greater Iran from Zabulistan in Persian mythology and son of Zal and Rudaba. In some ways, the position of Rostam in the historical tradition is parallel to that of Surena, the hero of the Carrhae. His figure was endowed with many features of the historical...

, the national legendary hero of Iran.

Types

There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...

, apart from the incision on the skin.
  • The classical Caesarean section involves a midline longitudinal incision
    Anatomical terms of location
    Standard anatomical terms of location are designations employed in science that deal with the anatomy of animals to avoid ambiguities that might otherwise arise. They are not language-specific, and thus require no translation...

     which allows a larger space to deliver the baby. However, it is rarely performed today as it is more prone to complications.
  • The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder
    Urinary bladder
    The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...

     and results in less blood loss
    Bleeding
    Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...

     and is easier to repair.
  • An unplanned Caesarean section is a Caesarean performed once labour has commenced due to unexpected labor complications.
  • A crash/emergent/emergency Caesarean section is a Caesarean performed in an obstetric emergency, where complications of pregnancy
    Complications of pregnancy
    Complications of pregnancy are the symptoms and problems that are associated with pregnancy. There are both routine problems and serious, even potentially fatal problems. The routine problems are normal complications, and pose no significant danger to either the woman or the fetus...

     onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both.
  • A Caesarean hysterectomy
    Hysterectomy
    A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...

     consists of a Caesarean section followed by the removal of the uterus
    Uterus
    The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...

    . This may be done in cases of intractable bleeding or when the placenta
    Placenta
    The placenta is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. "True" placentas are a defining characteristic of eutherian or "placental" mammals, but are also found in some snakes and...

     cannot be separated from the uterus.
  • Traditionally other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro
    Eduardo Porro
    Eduardo Porro was an Italian obstetrician. He was born in Padua and took his M. D. in 1865 at the University of Pavia, where, after spending several years as assistant at the Ospedale Maggiore at Milan, he became professor of obstetrics . From 1885 to 1892 he held a similar chair at Milan...

     Caesarean section.
  • a repeat Caesarean section is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.


In many hospitals, especially in Argentina
Argentina
Argentina , officially the Argentine Republic , is the second largest country in South America by land area, after Brazil. It is constituted as a federation of 23 provinces and an autonomous city, Buenos Aires...

, the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

, United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

, Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...

, Sweden
Sweden
Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....

, Finland
Finland
Finland , officially the Republic of Finland, is a Nordic country situated in the Fennoscandian region of Northern Europe. It is bordered by Sweden in the west, Norway in the north and Russia in the east, while Estonia lies to its south across the Gulf of Finland.Around 5.4 million people reside...

, Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...

, and New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...

 the mother's birth partner is encouraged to attend the surgery to support the mother and share the experience. The anaesthetist will usually lower the drape temporarily as the child is delivered so the parents can see their newborn.

Indications

Caesarean section is recommended when vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...

l delivery might pose a risk to the mother or baby. Not all of the listed conditions represent a mandatory indication, and in many cases the obstetrician must use discretion to decide whether a Caesarean is necessary. Some indications for Caesarean delivery are:

Complications of labor and factors impeding vaginal delivery such as
  • prolonged labour
    Childbirth
    Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

     or a failure to progress (dystocia
    Dystocia
    Dystocia is an abnormal or difficult childbirth or labour. Approximately one fifth of human labours have dystocia.Dystocia may arise due to incoordinate uterine activity, abnormal fetal lie or presentation, absolute or relative cephalopelvic disproportion, or a massive fetal tumor such as a...

    )
  • fetal distress
    Fetal distress
    In medicine , the term fetal distress refers to the presence of signs in a pregnant woman—before or during childbirth—that suggest that the fetus may not be well...

  • cord prolapse
    Cord prolapse
    Umbilical cord prolapse happens when the umbilical cord precedes the fetus' exit from the uterus. It is an obstetric emergency during pregnancy or labor that imminently endangers the life of the fetus. Cord prolapse is rare...

  • uterine rupture
    Uterine rupture
    Uterine rupture is a potentially catastrophic event during childbirth by which the integrity of the myometrial wall is breached. In an incomplete rupture the peritoneum is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament...

  • increased blood pressure (hypertension
    Hypertension
    Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...

    ) in the mother or baby after amniotic rupture
    Amniotic fluid
    Amniotic fluid or liquor amnii is the nourishing and protecting liquid contained by the amniotic sac of a pregnant woman.- Development of amniotic fluid :...

  • increased heart rate (tachycardia
    Tachycardia
    Tachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...

    ) in the mother or baby after amniotic rupture
    Amniotic fluid
    Amniotic fluid or liquor amnii is the nourishing and protecting liquid contained by the amniotic sac of a pregnant woman.- Development of amniotic fluid :...

  • placenta
    Placenta
    The placenta is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. "True" placentas are a defining characteristic of eutherian or "placental" mammals, but are also found in some snakes and...

    l problems (placenta praevia
    Placenta praevia
    Placenta praevia is an obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix. It can sometimes occur in the later part of the first trimester, but usually during the second or third. It is a leading cause of antepartum haemorrhage...

    , placental abruption
    Placental abruption
    Placental abruption is a complication of pregnancy, wherein the placental lining has separated from the uterus of the mother. It is the most common pathological cause of late pregnancy bleeding. In humans, it refers to the abnormal separation after 20 weeks of gestation and prior to birth...

     or placenta accreta
    Placenta accreta
    Placenta accreta is a severe obstetric complication involving an abnormally deep attachment of the placenta, through the endometrium and into the myometrium...

    )
  • abnormal presentation (breech
    Breech birth
    A breech birth is the birth of a baby from a breech presentation. In the breech presentation the baby enters the birth canal with the buttocks or feet first as opposed to the normal head first presentation....

     or transverse
    Transversality
    In mathematics, transversality is a notion that describes how spaces can intersect; transversality can be seen as the "opposite" of tangency, and plays a role in general position. It formalizes the idea of a generic intersection in differential topology...

     positions)
  • failed labour induction
  • failed instrumental delivery (by forceps
    Forceps
    Forceps or forcipes are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term 'forceps' is used almost exclusively...

     or ventouse
    Ventouse
    Ventouse is a vacuum device used to assist the delivery of a baby when the second stage of labour has not progressed adequately. It is an alternative to a forceps delivery and caesarean section. It cannot be used when the baby is in the breech position or for premature births. This technique is...

    . Sometimes a 'trial of forceps/ventouse' is tried out – This means a forceps/ventouse delivery is attempted, and if the forceps/ventouse delivery is unsuccessful, it will be switched to a Caesarean section.
  • overly large baby (macrosomia)
  • umbilical cord abnormalities (vasa previa, multi-lobate including bi-lobate and succenturiate-lobed placentas, velamentous insertion)
  • contracted pelvis


Other complications of pregnancy, preexisting conditions and concomitant disease such as
  • pre-eclampsia
    Pre-eclampsia
    Pre-eclampsia or preeclampsia is a medical condition in which hypertension arises in pregnancy in association with significant amounts of protein in the urine....

  • hypertension
  • multiple birth
    Multiple birth
    A multiple birth occurs when more than one fetus is carried to term in a single pregnancy. Different names for multiple births are used, depending on the number of offspring. Common multiples are two and three, known as twins and triplets...

    s
  • precious (High Risk) Fetus
  • HIV
    HIV
    Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

     infection of the mother
  • Sexually transmitted infections such as genital herpes (which can be passed on to the baby if the baby is born vaginally, but can usually be treated in with medication and do not require a Caesarean section)
  • previous Caesarean section (though this is controversial – see discussion below)
  • prior problems with the healing of the perineum
    Perineum
    In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...

     (from previous childbirth or Crohn's Disease
    Crohn's disease
    Crohn's disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms...

    )
  • Bicornuate uterus
    Bicornuate uterus
    A bicornuate uterus or bicornate uterus, commonly referred to as a "heart-shaped" uterus, is a type of uterine malformation where two "horns" form at the upper part of the uterus.-Pathophysiology:A bicornuate uterus is formed during embryogenesis....



Other
  • Lack of Obstetric Skill (Obstetricians not being skilled in performing breech births, multiple births, etc. [In most situations women can birth under these circumstances naturally. However, obstetricians are not always trained in proper procedures])
  • Improper Use of Technology (Electric Fetal Monitoring [EFM])

Risks for the mother

The mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...

 for both Caesarian sections and vaginal birth, in the Western world, continues to drop steadily. In 2000, the mortality rate for Caesareans in the United States were 20 per 1,000,000. The UK
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 gives the risk of death for the mother as three times that of a vaginal birth.
However, it is misleading to directly compare the mortality rates of vaginal and Caesarean deliveries. Women with severe medical conditions, or higher-risk pregnancies, often require a Caesarean section which can distort the mortality figures.

A study published in the 13 February 2007 issue of the Canadian Medical Association Journal found that the absolute differences in severe maternal morbidity and mortality was small, but that the additional risk over vaginal delivery should be considered by women contemplating an elective Caesarean delivery and by their physicians.

As with all types of abdominal surgery, a Caesarean section is associated with risks of post-operative adhesions
Adhesion (medicine)
Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected.-Pathophysiology:...

, incisional hernias (which may require surgical correction) and wound infections. If a Caesarean is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anaesthesia risk. Other risks include severe blood loss (which may require a blood transfusion) and post spinal headaches
Post dural puncture headache
Post-dural-puncture headache is a complication of puncture of the dura mater...

.

A study published in the June 2006 issue of the journal Obstetrics and Gynecology found that women who had multiple Caesarean sections were more likely to have problems with later pregnancies, and recommended that women who want larger families should not seek Caesarean section as an elective. The risk of placenta accreta
Placenta accreta
Placenta accreta is a severe obstetric complication involving an abnormally deep attachment of the placenta, through the endometrium and into the myometrium...

, a potentially life-threatening condition, is only 0.13% after two Caesarean sections but increases to 2.13% after four and then to 6.74% after six or more surgeries. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. The findings were based on outcomes from 30,132 Caesarean deliveries.

It is difficult to study the effects of Caesarean sections because it can be difficult to separate out issues caused by the procedure itself versus issues caused by the conditions that require it. For example, a study published in the February 2007 issue of the journal Obstetrics and Gynecology found that women who had just one previous Caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta
Placenta accreta
Placenta accreta is a severe obstetric complication involving an abnormally deep attachment of the placenta, through the endometrium and into the myometrium...

, prolonged labor, uterine
Uterine
The word uterine can refer to different meanings:* relating to or near the uterus or womb* having the same mother, but different fathers, see matrilineality...

 rupture, preterm birth, low birth weight, and stillbirth
Stillbirth
A stillbirth occurs when a fetus has died in the uterus. The Australian definition specifies that fetal death is termed a stillbirth after 20 weeks gestation or the fetus weighs more than . Once the fetus has died the mother still has contractions and remains undelivered. The term is often used in...

 in their second delivery. However, the authors conclude that some risks may be due to confounding factors related to the indication for the first Caesarean, rather than due to the procedure itself.

Risks for the child

This list is currently incomplete and should not be taken as comprehensive or reflective of current research. It covers some of the most commonly discussed risks to the child posed by the procedure itself rather than the medical indications that may call for it. Some risks are rare, and as with most medical procedures the likelihood of any risk is highly dependent on individual factors such as whether other pregnancy complications exist, whether the operation is planned or done as an emergency measure, and how and where it is performed.
  • Wet lung: retention of fluid in the lungs can occur if not expelled by the pressure of contractions during labor.

  • Potential for early delivery and complications: Pre-term delivery is possible if due date calculation is inaccurate. One study found an increased risk of complications if a repeat elective Caesarean section is performed even a few days before the recommended 39 weeks.

  • Higher infant mortality risk: in c-sections which are performed with no indicated risk (singleton at full term in a head-down position), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had c-sections, compared to 0.62 per 1,000 for women who delivered vaginally

Incidence

In 2004, the Caesarean rate was about 20% in the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, while the Canadian
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

 rate was 22.5% in 2001–2002.

In Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...

 the incidence of Caesarean sections is particularly high, although it varies from region to region. In Campania
Campania
Campania is a region in southern Italy. The region has a population of around 5.8 million people, making it the second-most-populous region of Italy; its total area of 13,590 km² makes it the most densely populated region in the country...

, 60% of 2008 births reportedly occurred via Caesarean sections. In the Rome
Rome
Rome is the capital of Italy and the country's largest and most populated city and comune, with over 2.7 million residents in . The city is located in the central-western portion of the Italian Peninsula, on the Tiber River within the Lazio region of Italy.Rome's history spans two and a half...

 region, the mean incidence is around 44%, but can reach as high as 85% in some private clinics.

In the United States the Caesarean rate has risen 48% since 1996, reaching a level of 31.8% in 2007. A 2008 report found that fully one-third of babies born in Massachusetts in 2006 were delivered by Caesarean section. In response, the state's Secretary of Health and Human Services, Dr. Judy Ann Bigby, announced the formation of a panel to investigate the reasons for the increase and the implications for public policy.

In Brazil's public health network, the rate reaches 35%, while in private hospitals the rate approaches 80%.

China has been cited as having the highest rates of C-sections in the world at 46% as of 2008

Studies have shown that continuity of care with a known carer may significantly decrease the rate of Caesarean delivery but there is also research that appears to show that there is no significant difference in Caesarean rates when comparing midwife continuity care to conventional fragmented care.

More emergency Caesareans—about 66%—are performed during the day rather than during the night.

Analyzing the rise in Caesarean section rates

The World Health Organization officially withdrew its previous recommendation of a 15% C-section rates in June of 2010. Their official statement read "There is no empirical evidence for an optimum percentage. What matters most is that all women who need caesarean sections receive them."

The US National Institutes of Health says that rises in rates of Caesarean sections are not, in isolation, a cause for concern, but may reflect changing reproductive patterns:


The World Health Organization has determined an “ideal rate” of all cesarean deliveries (such as 15 percent) for a population. One surgeon's opinion is that there is no consistency in this ideal rate, and artificial declarations of an ideal rate should be discouraged. Goals for achieving an optimal cesarean delivery rate should be based on maximizing the best possible maternal and neonatal outcomes, taking into account available medical and health resources and maternal preferences. This opinion is based on the idea that if left unchallenged, optimal cesarean delivery rates will vary over time and across different populations according to individual and societal circumstances.


There has been a rapid growth in the number of c-sections performed. For example, there has been a fourfold increase from 1971 to 1991. (From 4.2 c-sections per 100 births). This may be accredited to the improved technology in detecting pre-birth distress. Malpractice has been looked into because of the rapid increase in c-sections. Some argue that the higher costs of c-section births compared to regular births make physicians quicker to recommend a c-section. Usually, if a doctor makes a recommendation people are quick to take it to heart and act upon it. The effect of relative c-section price on c-section usage should be examined.

However, some commentators are concerned by the rise and have noted several evidence-based studies. Louise Silverton, deputy general-secretary of the Royal College of Midwives
Royal College of Midwives
The Royal College of Midwives is a British midwives organisation which has existed under its present name since 1947.-History:The Matrons' Aid Society, renamed the Midwives' Institute in 1881, was founded by Louisa Hubbard and Zepharina Veitch to raise the training and status of midwives...

, says that not only has society’s tolerance for pain and illness been “significantly reduced”, but also that women are scared of pain and think that if they have a Caesarean there will be less, if any, pain. It is the opinion of Silverton and the Royal College of Midwives that “women have lost their confidence in their ability to give birth."

Silverton's analysis is controversial among some surgeons. Dr Maggie Blott, a consultant obstetrician at University College Hospital, London and then a Royal College of Obstetricians and Gynaecologists (RCOG) spokeswoman on Caesareans (and Vice President of the RCOG), responded: 'There isn't any evidence to support Louise Silverton's view that increasingly pain-averse women are pushing up the Caesarean rate. There's an undercurrent that Caesarean sections are a bad thing, but they can be life-saving.'

A previously unexplored hypothesis for the increasing section rate is the evolution of birth weight and maternal pelvis size. It is proposed that since the advent of successful Caesarean birth over the last 150 years, mothers with a small pelvis and babies with a large birth weight have survived and contributed to these traits increasing in the population. Such a hypothesis is based upon the idea that even without fears of malpractice, without maternal obesity and diabetes, and without other widely quoted factors, the C-section rate would continue to rise simply due to slow changes in population genetics.

Elective Caesarean sections

Caesarean sections are in some cases performed for reasons other than medical necessity
Medical necessity
Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. Other countries may have medical doctrines or legal rules covering broadly similar grounds...

. Reasons for elective Caesareans vary, with a key distinction being between hospital or doctor-centric reasons and mother-centric reasons. Critics of doctor-ordered Caesareans worry that Caesareans are in some cases performed because they are profitable for the hospital, because a quick Caesarean is more convenient for an obstetrician than a lengthy vaginal birth, or because it is easier to perform surgery at a scheduled time than to respond to nature's schedule and deliver a baby at an hour that is not predetermined. Another reason for doctors to recommend C-section is money. In China, doctors are compensated based on the monetary value of medical treatments offered. As a result, doctors have an incentive to persuade mothers to choosing the more expensive C-section.

In this context, it is worth remembering that many studies have shown that operations performed out-of-hours tend to have more complications (both surgical and anaesthetic). For this reason if a Caesarean is anticipated to be likely to be needed for a woman, it may be preferable to perform this electively (or pre-emptively) during daylight operating hours, rather than wait for it to become an emergency with the increased risk of surgical and anaesthetic complications that can follow from emergency surgery.

Another contributing factor for doctor-ordered procedures may be fear of medical malpractice
Medical malpractice
Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Standards and...

 lawsuits. Italian gynaecologyst Enrico Zupi, whose clinic in Rome Mater Dai was under media attention for carrying a record of caesarian sections (90% over total birth), explained: “We shouldn't be blamed. Our approach must be understood. We doctors are often sued for events and complications that cannot be classified as malpractice. So we turn to defensive medicine. We will keep acting this way as long as medical mistakes are not depenalized. We are not martyr
Martyr
A martyr is somebody who suffers persecution and death for refusing to renounce, or accept, a belief or cause, usually religious.-Meaning:...

s. So if a pregnant woman is facing an even minimum risk, we suggest she gets a C-section "

Studies of United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 women have indicated that married white women giving birth in private hospitals are more likely to have a Caesarean section than poorer women even though they are less likely to have complications that may lead to a Caesarean section being required. The women in these studies have indicated that their preference for Caesarean section is more likely to be partly due to considerations of pain and vaginal tone. In contrast to this, a recent study in the British Medical Journal
British Medical Journal
BMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...

 retrospectively analysed a large number of Caesarean sections in England and stratified them by social class. Their finding was that Caesarean sections are not more likely in women of higher social class than in women in other classes. Some have suggested that due to the comparative risks of Caesarean section with an uncomplicated vaginal delivery, patients should be discouraged or forbidden from choosing it.

Some 42% of obstetricians believe the media and women are responsible for the rising Caesarean section rates. Some studies, however, conclude that relatively few women wish to be delivered by Caesarean section.

Anaesthesia

Both general and regional anaesthesia (spinal
Spinal anaesthesia
Spinal anaesthesia , also called spinal analgesia or sub-arachnoid block , is a form of regional anaesthesia involving injection of a local anaesthetic into the subarachnoid space, generally through a fine needle, usually 9 cm long...

, epidural
Epidural
The term epidural is often short for epidural analgesia, a form of regional analgesia involving injection of drugs through a catheter placed into the epidural space...

 or combined spinal and epidural anaesthesia
Combined spinal and epidural anaesthesia
Combined spinal and epidural anaesthesia is a regional anaesthetic technique, which combines the benefits of both spinal anaesthesia and epidural anaesthesia and analgesia. The spinal component gives a rapid onset of a predictable block...

) are acceptable for use during Caesarean section. Regional anaesthesia is preferred as it allows the mother to be awake and interact immediately with her baby. Other advantages of regional anesthesia include the absence of typical risks of general anesthesia: pulmonary aspiration
Pulmonary aspiration
Pulmonary aspiration is the entry of material from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract...

 (which has a relatively high incidence in patients undergoing anesthesia in late pregnancy) of gastric contents and Oesophageal
Esophagus
The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...

 intubation
Intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...

.

Regional anaesthesia is used in 95% of deliveries, with spinal and combined spinal and epidural anaesthesia being the most commonly used regional techniques in scheduled Caesarean section. Regional anaesthesia during Caesarean section is different to the analgesia (pain relief) used in labor and vaginal delivery. The pain that is experienced because of surgery is greater than that of labor and therefore requires a more intense nerve block
Nerve block
Regional nerve blockade, or more commonly nerve block, is a general term used to refer to the injection of local anesthetic onto or near nerves for temporary control of pain. It can also be used as a diagnostic tool to identify specific nerves as pain generators...

. The dermatomal level of anesthesia required for Caesarean delivery is also higher than that required for labor analgesia.

General anesthesia may be necessary because of specific risks to mother or child. Patients with heavy, uncontrolled bleeding may not tolerate the hemodynamic effects of regional anesthesia. General anesthesia is also preferred in very urgent cases, such as severe fetal distress, when there is no time to perform a regional anesthesia.

Vaginal birth after Caesarean

While vaginal births after caesarean (VBAC) are not uncommon today, the rate of VBAC has declined to include less than 10% of births after previous cesarean.
Although cesarean deliveries made up only 5% of births overall in the USA until the mid-1970s, it was commonly believed that for women with previous cesarean sections, "Once a Caesarean, always a Caesarean." A consumer-driven movement supporting VBAC changed medical practice and led to soaring rates of VBAC in the 80s and early 90s, but rates of VBAC dramatically dropped after the publication of a highly publicized scientific study showing worse outcomes for VBAC as compared to repeat cesarean and the resulting medico-legal changes within obstetrics. In 2010, the National Institutes of Health, U.S. Department of Health and Human Services, and American College of Obstetrics and Gynecology all released statements in support of increasing VBAC access and rates.
In the past, Caesarean sections used a vertical incision which cut the uterine muscle fibres in an up and down direction (a classical Caesarean). Modern Caesareans typically involve a horizontal incision along the muscle fibres in the lower portion of the uterus (hence the term lower uterine segment Caesarean section, LUSCS/LSCS). The uterus then better maintains its integrity and can tolerate the strong contractions of future childbirth. Cosmetically the scar for modern Caesareans is below the "bikini line".
Obstetricians and other caregivers differ on the relative merits of vaginal and Caesarean section following a Caesarean delivery; some still recommend a Caesarean routinely, while others do not. In the US, the American College of Obstetricians and Gynecologists (ACOG) modified the guidelines on vaginal birth after previous Caesarean delivery in 1999, 2004, and again in 2010.. In 2004, this modification to the guideline included the addition of the following recommendation:

Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.
In 2010, ACOG modified these guidelines again to express more encouragement of VBAC but maintained that it should still be undertaken at facilities capable of emergency care, even though patient autonomy in assuming increased levels of risk should be respected (ACOG Practice Bulletin Number 115, August 2010).
The recommendation for access to emergency care during trial of labor has, in some cases, had a major impact on the availability of VBACs to birthing mothers in the US. For example, a study of the change in frequency of VBAC deliveries in California after the change in guidelines, published in 2006, found that the VBAC rate fell to 13.5% after the change, compared with 24% VBAC rate before the change. The new recommendation has been interpreted by many hospitals as indicating that a full surgical team must be standing by to perform a Caesarean section for the full duration of a VBAC woman's labor. Hospitals that prohibit VBACs entirely are said to have a 'VBAC ban'. In these situations, birthing mothers are forced to choose between having a repeat Caesarean section, finding an alternate hospital in which to deliver their baby or attempting delivery outside the hospital setting.
Most recently, enhanced access to VBAC has been recommended based on updated scientific data on the safety of VBAC as compared to repeat cesarean section, including the following recommendation emerging from the NIH VBAC conference panel in March 2010, "We recommend that hospitals, maternity care providers, health care and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to trial of labor." The U.S Department of Health and Human Services' Healthy People 2020 initiative includes objectives to reduce the primary cesarean rate and to increase the VBAC rate by at least 10% each.

Recovery period

Typically the recovery time depends on the patient and her pain/ inflammation levels. Doctors do recommend no strenuous work i.e. lifting objects over 10 lbs., running, walking up stairs, or athletics for up to six weeks.

Within Judaism

There is a dispute among the poskim (Rabbinic authorities) as to whether a first born son from a Caesarean section has the laws of a Bechor
Bechor
The firstborn or firstborn son is an important concept of the Hebrew Bible and Rabbinic Judaism. The role of firstborn son carries significance in the redemption of the first born son, in the allocation of a double portion of the inheritance, and in the prophetic application of "firstborn" to the...

. Traditionally, a male child delivered by Cesarean is not eligible for the Pidyon HaBen
Pidyon HaBen
The Pidyon HaBen, or Redemption of the first born son, is a mitzvah in Judaism whereby a Jewish firstborn son is redeemed by use of silver coins from his birth-state of sanctity....

dedication ritual.

External links

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