A Caesarean section also C-section, Caesarian section, Cesarian section, is a surgical procedure in which one or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed a hysterotomy abortion and is very rarely performed.
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 for childbirths 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 countries, Latin America, and the USA.
Successful Caesarean section performed by indigenous healers in Kahura, Uganda. As observed by R. W. Felkin in 1879.
Bindusara (Born c. 320 BC, ruled: 298 – c.272 BC) , the second Mauryan emperor of India after Chandragupta Maurya the Great, is said to be first child born by surgery. Her mother, wife of Chandragupta Maurya, when she was pregnant and was about to deliver, accidentally consumed poison and died. Chanakya, 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.
Pliny the Elder 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). 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, 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 saint Raymond Nonnatus (1204–1240), received his surname—from the Latin 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 was delivered by Caesarean section—his mother, Marjorie Bruce, died. This may have been the inspiration for Macduff in Shakespeare’s play Macbeth”. (see below).
Caesarean section usually resulted in the death of the mother; the first recorded incidence of a woman surviving a Caesarean section was in 1500, in Siegershausen, Switzerland: Jakob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labour. For most of the time since the sixteenth century, the procedure had a high mortality 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:
- Adherence to principles of asepsis.
- The introduction of uterine suturing by Max Sänger in 1882.
- Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912).
- Anesthesia advances.
- Blood transfusion.
European travelers in the Great Lakes region of Africa 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 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 is mentioned in the book of Shahnameh, written around 1000 AD, and relates to the birth of Rostam, the national legendary hero of Iran.
There are several types of Caesarean section (CS). An important distinction lies in the type of incision (longitudinal or latitudinal) made on the uterus, apart from the incision on the skin.
- The classical Caesarean section involves a midline longitudinal incision 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 and results in less blood loss and is easier to repair.
- An emergency Caesarean section is a Caesarean performed once labour has commenced.
- A crash Caesarean section is a Caesarean performed in an obstetric emergency, where complications of pregnancy 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 consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
- Traditionally other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro 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, the United States, United Kingdom, Canada, Norway, Sweden, Australia, and New Zealand 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.