Julius Caesar was purportedly delivered from his dead mother, alive and well, after her belly was cut open immediately upon her demise, giving rise to the common name for the operative delivery of a baby – the Caesarean section. In fact it is unlikely this scenario occurred, but caedere means “to cut” in Latin, and those delivered immediately after the death of a mother in childbirth by being cut from the mother’s womb were called caesones. It is far more likely that Julius Caesar was a descendent from such a caesones and his family adopted that title as their surname. The man was probably named for the operation and not the reverse.
In the last 2000 years the operation has been considerably refined to the point where about a quarter of all babies are now delivered in this manner.
There are obvious situations where a caesarean section is the only choice for the obstetrician. These include a baby that is presenting side on instead of head-first, a placenta (afterbirth) that is over the birth canal, a severely ill mother, a distressed infant that may not survive the rigours of the passage through the birth canal, and the woman who has been labouring for many hours with no success.
Caesarean sections may also be performed if the mother has had a previous operative birth, if she is very small, if previous children have had birth injuries or required forceps delivery, for a baby presenting bottom first, if the baby is very premature or delicate, in multiple pregnancies where the two or more babies may become entangled, and in a host of other combinations and permutations of circumstances that cannot be imagined in advance. The decision to undertake the operation is often difficult, but it will always have to be up to the judgement and clinical acumen of the obstetrician, in consultation with the mother if possible, to make the final decision.
In developed countries the rate at which Caesarean sections are performed is steadily rising. The reasons for this include the convenience of the mother, the convenience of the doctor, the legal risks associated with natural labour and the medical risks. The rate now exceeds a quarter of all deliveries in many areas, and up to 28% in some countries, an increase from less than 20% ten years ago.
The operation is extremely safe to both mother and child. A spinal or epidural anaesthetic is given to the mother, and the baby is usually delivered within five minutes. A general anaesthetic is these days only given in some specific circumstances. After delivery the longer and more complex task of repairing the womb and abdominal muscles is undertaken. In most cases, the scar of a caesarean is low and horizontal, below the bikini line, to avoid any disfigurement.
With epidural or spinal anaesthesia, a needle is placed in the middle of the mother’s back, and through this an anaesthetic is introduced. The woman feels nothing below the waist, and although sedated is quite awake and able to participate in the birth of her baby, seeing it only seconds after it is delivered by the surgeon. Some doctors and hospitals allow the woman’s partner to be present during these deliveries.
Recovery from a caesarean is slower than for normal childbirth, but most women leave hospital within seven days. It does not affect breastfeeding or the chances of future pregnancies, and does not increase the risk of miscarriage.