A Caesarian section (or Cesarean section in American English), also known as C-section or Caesar, is a surgical procedure in which incisions are 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 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.
The World Health Organization (WHO) recommends that the rate of Caesarean sections should not exceed 15% in any country. However, 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.
Caesarean section is recommended when vaginal 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 labor or a failure to progress (dystocia)
- fetal distress
- cord prolapse
- uterine rupture
- placental problems (placenta praevia, placental abruption or placenta accreta)
- abnormal presentation (breech or transverse positions)
- failed labor induction
- failed instrumental delivery (by forceps or ventouse.
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
- contracted pelvis
Other complications of pregnancy, preexisting conditions and concomitant disease such as
- multiple births
- precious (High Risk) Fetus
- HIV 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
- previous Caesarean section (though this is controversial – see discussion below)
- prior problems with the healing of the perineum (from previous childbirth or Crohn's Disease)
- Lack of Obstetric Skill (Obstetricians not being skilled
in performing breech births, multiple births, etc. 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 unit to drain the body fluids to prevent infection.
There are three theories about the origin of the name:
- The name for the procedure is said to derive from a Roman
legal code called "Lex Caesarea", which allegedly contained a law
prescribing that the baby be cut out of its mother's womb in the case
that she dies before giving birth. (The Merriam-Webster dictionary is
unable to trace any such law; but "Lex Caesarea" might mean simply
"imperial law" rather than a specific statute of Julius Caesar.)
- The derivation of the name is also often attributed to an
ancient story, told in the first century C.E. by Pliny the Elder, which
claims that an ancestor of Caesar was delivered in this manner.
- An alternative etymology suggests that the procedure's
name derives from the Latin verb ''caedere'' (supine stem ''caesum''),
"to cut," in which case the term "Caesarean section" is redundant.
Proponents of this view consider the traditional derivation to be a
false etymology, though the supposed link with Julius Caesar has
clearly influenced the spelling. (A corollary suggesting that Julius
Caesar himself derived his name from the operation is refuted by the
fact that the cognomen "Caesar" had been used in the Julii family for
centuries before his birth, and the ''Historia Augusta'' cites three
possible sources for the name Caesar, none of which have to do with
Caesarean sections or the root word ''caedere''.)
The link with the Roman dictator Julius Caesar, or with
Roman Emperors generally, exists in other languages as well. For
example, the modern German, Danish, Dutch and Hungarian terms are
respectively ''Kaiserschnitt'', ''kejsersnit'', ''keizersnede'' and
''császármetszés'' (literally: "Emperor's cut"). The German term has
also been imported into Japanese (帝王切開) and Korean (제왕 절개), both
literally meaning "emperor incision." The South Slavic term is ''carski
rez'', which literally means ''tzar cut'', whereas the Western Slavic
(Polish) has an analogous term: cesarskie cięcie. The Russian term
''kesarevo secheniye'' (кесарево сечение) literally means ''Caesar's
section''. The Arabic term (القيصرية) also means pertaining to Caesar
or literally Caesarean.
In Romania and Portugal it is usually called ''cesariana'',
meaning from (or related to) Caesar. The expression in Portuguese
usually does not include other words to designate the section. Usual
uses of the term are ''I'm going to have a cesariana next week'' or ''I
was delivered by cesariana''.
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