Caesarean section

Caesarean section
Cesarian the moment of birth3.jpg
A team performing a caesarean section[1]
Other namesC-section, cesarean section, caesarean delivery
ICD-10-PCS10D00Z0
74
D002585
002911

Caesarean section, also known as C-section, or caesarean delivery, is the use of surgery to deliver babies.[2] A caesarean section is often necessary when a vaginal delivery would put the baby or mother at risk.[2] This may include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, or 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] Some C-sections are performed without a medical reason, upon request by someone, usually the mother.[2]

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 longer to heal from, about six weeks, 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] Descriptions of mothers surviving date back to 1500.[10] With the introduction of antiseptics and anesthetics in the 19th century, survival of both the mother and baby became common.[10]

Uses

A 7-week old caesarean section scar and linea nigra visible on a 31-year-old mother: Longitudinal incisions are still sometimes used.

Caesarean section is recommended when vaginal delivery might pose a risk to the mother or baby. C-sections are also carried out for personal and social reasons on maternal request in some countries.

Medical uses

Complications of labor and factors increasing the risk associated with vaginal delivery include:

Other complications of pregnancy, pre-existing conditions, and concomitant disease, include:

Other

  • Decreasing experience of accoucheurs with the management of breech presentation. Although obstetricians and midwives are extensively trained in proper procedures for breech presentation deliveries using simulation mannequins, there is decreasing experience with actual vaginal breech delivery, which may increase the risk.[12]

Prevention

The prevalence of caesarean section is generally agreed to be higher than needed in many countries, and physicians are encouraged to actively lower the rate, as a caesarean rate higher than 10-15% is not associated with reductions in maternal or infant mortality rates,[4] although some evidence support that a higher rate of 19% may result in better outcomes.[8]

Some of these efforts are: emphasizing a long latent phase of labor is not abnormal and not a justification for C-section; a new definition of the start of active labor from a cervical dilatation of 4 cm to a dilatation of 6 cm; and allowing women who have previously given birth to push for at least 2 hours, with 3 hours of pushing for women who have not previously given birth, before labor arrest is considered.[3] Physical exercise during pregnancy decreases the risk.[13]