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A caesarean section, (or caesarian section or cesarean section or c-section) is a medical procedure which involves surgically delivering a baby through an incision in the abdomen. It is apparently an ancient procedure; Greek mythology relates that Apollo removed Asclepius, founder of the famous cult of religious medicine, from his mother's abdomen. References to caesareans appear in Hindu, Egyptian, Grecian, Roman, and other European folklore, as well as the Talmud, and ancient Chinese etchings show the procedure being done on apparently living women. The procedure was called a caesarean operation until after the publication in 1598 of Jacques Guillimeau's book on midwifery, in which he introduced the term caesarean section; I'm not sure what the section signifies, but it stuck. Why caesarean? Possibly after Julius Caesar, who, legend relates, was born in this way, or from the Latin verb caedare, to cut; children born by post-mortem operations were called caesones. Indeed, until relatively recently the procedure was reserved for cases where the mother was dying or dead, and it was used as a last resort in an often vain attempt to save the infant's life. Preservation of the mother's life was not generally an issue, although in 1500 a Swiss sow gelder, Jacob Nufer, apparently successfully saved his wife and baby with a caesarean section.

Today, caesarean sections have become one of the most common surgical procedures performed in North America; the incidence in Europe is generally a bit lower, and in the "developing" world, much lower, than in the United States and Canada. Caesareans are usually performed when a doctor believes that the presence of one or more risk factors could make natural childbirth dangerous: a mother's narrow pelvis; the presence of pelvic tumours; the presence of an active infection such as herpes simplex virus which could be transmitted to the child; the fetus being in a breech position; dystocia (non-progressing labour) or toxemia; or multiple babies. In addition, women who have already delivered one child by caesarean are often recommended to have subsequent caesarean deliveries. Although historically the mother's health was the most important factor in deciding to perform a caesarean, the recent development of technology to monitor the fetus has seen increasing numbers of caesarean sections performed to alleviate fetal distress.

Caesarean sections are necessary and often life-saving surgery for both mothers and children in perhaps 10 to 15% of all births. However, caesarean section rates can be as high as 30% in many areas of the "developed" world, showing that many more c-sections are performed than are necessary. Critics of caesarean sections point out that c-section births carry a much greater risk of mortality for the mother than vaginal births (1 in 2,500 vs. 1 in 10,000). In addition, caesarean sections are major surgery with all its attendant risks: reaction to anaesthesia, blood loss, after-surgery infection, long hospital stay, long recovery time. Studies have also shown that after emergency caesarean sections many women report that they feared for their own lives and the lives of their children and that they blamed themselves for the event. Women who deliver by c-section tend to have less positive birth experiences than those who deliver vaginally; they are more likely to view their birth experience as traumatic and unsatisfactory. Also, caesarean sections are more expensive procedures for the individuals involved and for the health care system than vaginal births.

Which women who are routinely having caesarean sections could, in fact, be delivering vaginally? In the last decade or so it has become increasingly recognized that vaginal birth after caesarian (VBAC) is a viable, and indeed preferable, option; more than 75% of women who have had a caesarean birth can go on to deliver vaginally. The majority of breech births can be successfully delivered vaginally. Women with non-progressing labour may simply require more time to achieve vaginal delivery. The majority whose dystocia led to c-sections go on to deliver vaginally in subsequent births, and critics of medicalized childbirth suspect that being administered an epidural to ease pain during labour may be the biggest cause of non-progressive labour for first-time mothers. In the United States women who are attended by midwives have a fifth as many caesarean sections as those who are attended only by physicians. It is being increasingly recognized in the medical establishment and without that optimal caesarean rates should fall at about 12%, and that many caesarean sections can, and should, be avoided.

If you want to find out more about caesarean sections, here are a few places to start:
www.facs.org/public_info/operation/cesarean.pdf (note: PDF file)

And for a fascinating history of caesarean sections, see

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