Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the

surgical procedure Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because

vaginal delivery In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...

would put the mother or child at risk (of paralysis or even death). Reasons for the operation include, but are not limited to,

obstructed labor Obstructed labour, also known as labour dystocia, is the baby not exiting the pelvis because it is physically blocked during childbirth although the uterus contracts normally. Complications for the baby include Perinatal asphyxia, not getting e ...

twin pregnancy Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of Twin Last Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two e ...

high blood pressure Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major ri ...

in the mother,

breech birth A breech birth is when a baby is born bottom first instead of Cephalic presentation, head first, as is normal. Around 3–5% of pregnant women at term (37–40 weeks pregnant) have a breech baby. Due to their higher than average rate of possible ...

, shoulder presentation, and problems with the

placenta The placenta (: placentas or placentae) is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas, and waste exchange between ...

umbilical cord In Placentalia, placental mammals, the umbilical cord (also called the navel string, birth cord or ''funiculus umbilicalis'') is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord i ...

. A caesarean delivery may be performed based upon the shape of the mother's

pelvis The pelvis (: pelves or pelvises) is the lower part of an Anatomy, anatomical Trunk (anatomy), trunk, between the human abdomen, abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also c ...

or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

recommends that caesarean section be performed only when medically necessary. A C-section typically takes 45 minutes to an hour. It may be done with a spinal block, where the woman is awake, or under

general anesthesia General anaesthesia (UK) or general anesthesia (US) is medically induced loss of consciousness that renders a patient unarousable even by painful stimuli. It is achieved through medications, which can be injected or inhaled, often with an analgesi ...

. A urinary catheter is used to drain the

bladder The bladder () is a hollow organ in humans and other vertebrates that stores urine from the kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the bladder is a distens ...

, and the skin of the

abdomen The abdomen (colloquially called the gut, belly, tummy, midriff, tucky, or stomach) is the front part of the torso between the thorax (chest) and pelvis in humans and in other vertebrates. The area occupied by the abdomen is called the abdominal ...

is then cleaned with an

antiseptic An antiseptic ( and ) is an antimicrobial substance or compound that is applied to living tissue to reduce the possibility of sepsis, infection, or putrefaction. Antiseptics are generally distinguished from ''antibiotics'' by the latter's abil ...

. An incision of about 15 cm (6 inches) is then typically made through the mother's lower abdomen. The

uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...

is then opened with a second incision and the baby delivered. The incisions are then stitched closed. A woman can typically begin

breastfeeding Breastfeeding, also known as nursing, is the process where breast milk is fed to a child. Infants may suck the milk directly from the breast, or milk may be extracted with a Breast pump, pump and then fed to the infant. The World Health Orga ...

as soon as she is out of the

operating room Operation or Operations may refer to: Arts, entertainment and media * ''Operation'' (game), a battery-operated board game that challenges dexterity * Operation (music), a term used in musical set theory * ''Operations'' (magazine), Multi-Man ...

and awake. Often, several days are required in the hospital to recover sufficiently to return home. C-sections result in a small overall increase in poor outcomes in low-risk pregnancies. They also typically take about six weeks to heal from, longer than vaginal birth. The increased risks include breathing problems in the baby and

amniotic fluid embolism An amniotic fluid embolism (AFE) is a life-threatening childbirth ( obstetric) emergency in which amniotic fluid enters the blood stream of the mother, triggering a serious reaction which results in cardiorespiratory (heart and lung) collapse a ...

and postpartum bleeding in the mother. Established guidelines recommend that caesarean sections not be used before 39 weeks of pregnancy without a medical reason. The method of delivery does not appear to affect subsequent sexual function. In 2012, about 23 million C-sections were done globally. The international healthcare community has previously considered the rate of 10% and 15% ideal for caesarean sections. Some evidence finds a higher rate of 19% may result in better outcomes. More than 45 countries globally have C-section rates less than 7.5%, while more than 50 have rates greater than 27%. Efforts are being made to both improve access to and reduce the use of C-section. In the United States as of 2017, about 32% of deliveries are by C-section. The surgery has been performed at least as far back as 715 BC following the death of the mother, with the baby occasionally surviving. A popular idea is that the Roman statesman

Julius Caesar Gaius Julius Caesar (12 or 13 July 100 BC – 15 March 44 BC) was a Roman general and statesman. A member of the First Triumvirate, Caesar led the Roman armies in the Gallic Wars before defeating his political rival Pompey in Caesar's civil wa ...

was born via caesarean section and is the namesake of the procedure, but if this is the true etymology, it is based on a misconception: until the modern era, C-sections seem to have been invariably fatal to the mother, and Caesar's mother Aurelia not only survived her son's birth but lived for nearly 50 years afterward. There are many ancient and medieval legends, oral histories, and historical records of laws about C-sections around the world, especially in Europe, the Middle East and Asia. The first recorded successful C-section (where both the mother and the infant survived) was performed on a woman in Switzerland in 1500 by her husband, Jakob Nufer, though this was not recorded until 8 decades later. With the introduction of antiseptics and anesthetics in the 19th century, the survival of both the mother and baby, and thus the procedure, became significantly more common.

Uses

Caesarean section (C-section) is recommended when

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: * Abnormal presentation ( breech or transverse positions) * Prolonged

labor Labour or labor may refer to: * Childbirth, the delivery of a baby * Labour (human activity), or work ** Manual labour, physical work ** Wage labour, a socioeconomic relationship between a worker and an employer ** Organized labour and the labour ...

or a failure to progress ( obstructed labour, also known as dystocia) *

Fetal distress Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or Childbirth, labor in which the fetus shows signs of inadequate oxygenation. Due to its imprecision, the term "fetal distress" has fallen out of use in Ame ...

Cord prolapse Cord or CORD may refer to: Common meanings * String (structure), String * Thin rope * Twine * Cord (unit) used for measuring wood * Power cord * Umbilical cord Cord or CORD may also refer to: Places * Cord, Arkansas People * Alex Cord ( ...

* Uterine rupture or an elevated risk thereof * Uncontrolled

hypertension Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...

pre-eclampsia Pre-eclampsia is a multi-system disorder specific to pregnancy, characterized by the new onset of hypertension, high blood pressure and often a significant amount of proteinuria, protein in the urine or by the new onset of high blood pressure a ...

, or

eclampsia Eclampsia is the onset of seizures (convulsions) in a pregnant woman with pre-eclampsia. Pre-eclampsia is a hypertensive disorder of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of proteinuria ...

in the mother *

Tachycardia Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal ...

in the mother or baby after amniotic rupture (the waters breaking) *

Placenta The placenta (: placentas or placentae) is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas, and waste exchange between ...

problems ( placenta praevia, placental abruption or placenta accreta) * Failed

labor induction Labor induction is the procedure where a medical professional starts the process of labor ( giving birth) instead of letting it start on its own. Labor may be induced (started) if the health of the mother or the baby is at risk. Induction of lab ...

* Failed instrumental delivery (by

forceps Forceps (: forceps or considered a plural noun without a singular, often a pair of forceps; the Latin plural ''forcipes'' is no longer recorded in most dictionaries) are a handheld, hinged instrument used for grasping and holding objects. Forcep ...

or ventouse (Sometimes, a trial of forceps/ventouse delivery is attempted, and if unsuccessful, the baby will need to be delivered by caesarean section.) * Large baby weighing > 4,000 grams (

macrosomia Large for gestational age (LGA) is a term used to describe infants that are born with an abnormally high weight, specifically in the 90th percentile or above, compared to other babies of the same developmental age. Macrosomia is a similar term tha ...

) * Umbilical cord abnormalities ( vasa previa, multilobate including bilobate and succenturiate-lobed placentas, velamentous insertion) Other complications of pregnancy, pre-existing conditions, and concomitant diseases, include: * Previous (high risk) fetus * HIV infection of the mother with a high viral load (HIV with a low maternal viral load is not necessarily an indication for caesarean section) * An outbreak of

genital herpes Genital herpes is a herpes infection of the genitals caused by the herpes simplex virus (HSV). Most people either have no or mild symptoms and thus do not know they are infected. When symptoms do occur, they typically include small blisters ...

in the third trimester (which can cause infection in the baby if born vaginally) * Previous classical (longitudinal) caesarean section * Previous uterine rupture * Prior problems with the healing of the

perineum The perineum (: perineums or perinea) in placentalia, placental mammals is the space between the anus and the genitals. The human perineum is between the anus and scrotum in the male or between the anus and vulva in the female. The perineum is ...

(from previous childbirth or

Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the ...

) *

Bicornuate uterus A bicornuate uterus or bicornate uterus (from the Latin ''cornū'', meaning "horn"), is a type of müllerian anomalies, Müllerian anomaly in the human uterus, where there is a deep indentation at the Uterus#Structure, fundus (top) of the uterus. ...

* Rare cases of posthumous birth after the death of the mother 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.

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, although some evidence support that a higher rate of 19% may result in better outcomes. Some of these efforts include 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.

Physical exercise Exercise or workout is physical activity that enhances or maintains fitness and overall health. It is performed for various reasons, including weight loss or maintenance, to aid growth and improve strength, develop muscles and the cardio ...

during pregnancy decreases the risk. Additionally, results from a 2021 systematic review of the evidence on outpatient cervical ripening found that in women with low-risk pregnancies, the risk of caesarean delivery with harm to the mother or child was not significantly different from when done in an inpatient setting.

Risks

Adverse outcomes in low-risk pregnancies occur in 8.6% of vaginal deliveries and 9.2% of caesarean section deliveries.

Mother

In those who are low risk, the risk of death for caesarean sections is 13 per 100,000 vs. for vaginal birth 3.5 per 100,000 in the developed world. The United Kingdom

National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...

gives the risk of death for the mother as three times that of a vaginal birth. In Canada, the difference in serious morbidity or mortality for the mother (e.g. cardiac arrest, wound hematoma, or hysterectomy) was 1.8 additional cases per 100. The difference in in-hospital maternal death was not significant. Normal post-Caesarean

A caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction), and wound infections. If a caesarean is performed in an emergency, the risk of the surgery may be increased due to several factors. The patient's stomach may not be empty, increasing the risk of anaesthesia. Other risks include severe blood loss (which may require a blood transfusion) and post-dural-puncture spinal- headaches. Wound infections occur after caesarean sections at a rate of 3–15%. The presence of chorioamnionitis and

obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...

predisposes the woman to develop a surgical site infection. Women who had caesarean sections are more likely to have problems with later pregnancies, and women who want larger families should not seek an elective caesarean unless medical indications to do so exist. The risk of placenta accreta, a potentially life-threatening condition that is more likely to develop where a woman has had a previous caesarean section, is 0.13% after two caesarean sections, but increases to 2.13% after four and then to 6.74% after six or more. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. Mothers can experience an increased incidence of postnatal depression, and can experience significant psychological trauma and ongoing birth-related post-traumatic stress disorder after obstetric intervention during the birthing process. Factors like pain in the first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the subsequent development of psychological issues related to labor and delivery.

Subsequent pregnancies

Women who have had a caesarean for any reason are somewhat less likely to become pregnant again as compared to women who have previously delivered only vaginally. Women who had just one previous caesarean section are more likely to have problems with their second birth. Delivery after previous caesarean section is by either of two main options: * Vaginal birth after caesarean section (VBAC) * Elective repeat caesarean section (ERCS) Both have higher risks than a vaginal birth with no previous caesarean section. A vaginal birth after caesarean section (VBAC) confers a higher risk of uterine rupture (5 per 1,000), blood transfusion or endometritis (10 per 1,000), and

perinatal death Perinatal mortality (PNM) is the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. ''Perinatal'' means "relating to the period starting a few weeks before birth and including the birth and a few weeks after bi ...

of the child (0.25 per 1,000). Furthermore, 20% to 40% of planned VBAC attempts end in caesarean section being needed, with greater risks of complications in an emergency repeat caesarean section than in an elective repeat caesarean section. On the other hand, VBAC confers less maternal morbidity and a decreased risk of complications in future pregnancies than elective repeat caesarean section.

Adhesions

Several steps can be taken during abdominal or pelvic surgery to minimize postoperative complications, such as developing adhesions. Such techniques and principles may include: * Handling all tissue with absolute care * Using powder-free surgical gloves * Controlling bleeding * Choosing sutures and implants carefully * Keeping tissue moist * Preventing infection with antibiotics given intravenously to the mother before skin incision Despite these proactive measures, adhesion formation is a recognized abdominal or pelvic surgery complication. To prevent adhesions from forming after caesarean section, adhesion barrier can be placed during surgery to minimize the risk of adhesions between the uterus and ovaries, the small bowel, and almost any tissue in the abdomen or pelvis. This is not current UK practice, as there is no compelling evidence to support the benefit of this intervention. Adhesions can cause long-term problems, such as: *

Infertility In biology, infertility is the inability of a male and female organism to Sexual reproduction, reproduce. It is usually not the natural state of a healthy organism that has reached sexual maturity, so children who have not undergone puberty, whi ...

, which may end when adhesions distort the tissues of the ovaries and tubes, impeding the normal passage of the egg (ovum) from the ovary to the uterus. One in five infertility cases may be adhesion-related (stoval) * Chronic pelvic pain, which may result when adhesions are present in the pelvis. Almost 50% of chronic pelvic pain cases are estimated to be adhesion-related (stoval) * Small bowel obstruction: the disruption of normal bowel flow, which can result when adhesions twist or pull the small bowel. The risk of adhesion formation is one reason why vaginal delivery is usually considered safer than elective caesarean section where there is no medical indication for section for either maternal or fetal reasons.

Child

Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Newborn mortality at 37 weeks may be up to 3 times the number at 40 weeks and is elevated compared to 38 weeks gestation. These early-term births were associated with more death during infancy, compared to those occurring at 39 to 41 weeks (full-term). Researchers in one study and another review found many benefits to going full term, but no adverse effects in the health of the mothers or babies. The American Congress of Obstetricians and Gynecologists and medical policymakers review research studies and find more incidence of suspected or proven

sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...

, RDS, hypoglycemia, need for respiratory support, need for NICU admission, and need for hospitalization > 4–5 days. In the case of caesarean sections, rates of respiratory death were 14 times higher in pre-labor at 37 compared with 40 weeks gestation, and 8.2 times higher for pre-labor caesarean at 38 weeks. In this review, no studies found decreased neonatal morbidity due to non-medically indicated (elective) delivery before 39 weeks. For otherwise healthy

twin Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of Twin Last Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two ...

pregnancies where both twins are head down a trial of

is recommended at between 37 and 38 weeks. Vaginal delivery, in this case, does not worsen the outcome for either infant as compared with caesarean section. There is some controversy on the best method of delivery where the first twin is head first and the second is not, but most obstetricians will recommend normal delivery unless there are other reasons to avoid vaginal birth. When the first twin is not head down, a caesarean section is often recommended. Regardless of whether the twins are delivered by section or vaginally, the medical literature recommends delivery of dichorionic twins at 38 weeks, and monochorionic twins (identical twins sharing a placenta) by 37 weeks due to the increased risk of stillbirth in monochorionic twins who remain in utero after 37 weeks. The consensus is that late preterm delivery of monochorionic twins is justified because the risk of stillbirth for post-37-week delivery is significantly higher than the risks posed by delivering monochorionic twins near term (i.e., 36–37 weeks). The consensus concerning monoamniotic twins (identical twins sharing an amniotic sac), the highest risk type of twins, is that they should be delivered by caesarean section at or shortly after 32 weeks since the risks of intrauterine death of one or both twins are higher after this gestation than the risk of complications of prematurity. In a research study widely publicized, singleton children born earlier than 39 weeks may have developmental problems, including slower learning in reading and math. Other risks include: * Wet lung (Transient Tachypnea of the Newborn): Failure to pass through the birth canal does not expose the baby to cortisol and epinephrine which typically would reverse the potassium/sodium pumps in the baby's lung. This causes fluid to remain in the lung. * Potential for early delivery and complications: Preterm delivery may be inadvertently carried out if the due date calculation is inaccurate. One study found an increased complication risk if a repeat elective caesarean section is performed even a few days before the recommended 39 weeks. * Higher infant mortality risk: In caesarean sections performed with no indicated medical risk (singleton at full term in a head-down position with no other obstetric or medical complications), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had caesarean sections, compared to 0.62 per 1,000 for women who delivered vaginally. Birth by caesarean section also seems to be associated with worse health outcomes later in life, including overweight or obesity, problems in the immune system, and poor digestive system. However, caesarean deliveries are found to not affect a newborn's risk of developing food allergies. This finding contradicts a previous study that claims babies born via caesarean section have lower levels of ''

Bacteroides ''Bacteroides'' is a genus of Gram-negative, obligate anaerobic bacteria. ''Bacteroides'' species are non endospore–forming bacilli, and may be either motile or nonmotile, depending on the species. The DNA base composition is 40–48% GC. Un ...

'' that is linked to peanut allergy in infants.

Classification

Caesarean sections have been classified in various ways by different perspectives. One way to discuss all classification systems is to group them by their focus either on the urgency of the procedure (most common), characteristics of the mother, or as a group based on other, less commonly discussed factors.

By urgency

Conventionally, caesarean sections are classified as being either an

elective surgery Elective surgery or elective procedure is surgery that is scheduled in advance because it does not involve a medical emergency. Semi-elective surgery is a surgery that must be done to preserve the patient's life, but does not need to be performe ...

or an

emergency An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...

operation. Classification is used to help communication between the obstetric, midwifery and anaesthetic team for discussion of the most appropriate method of anaesthesia. The decision whether to perform

or regional anesthesia (spinal or epidural anaesthetic) is important and is based on many indications, including how urgent the delivery needs to be as well as the medical and obstetric history of the woman. Regional anaesthetic is almost always safer for the woman and the baby but sometimes general anaesthetic is safer for one or both, and the classification of urgency of the delivery is an important issue affecting this decision. A planned caesarean (or elective/scheduled caesarean), arranged ahead of time, is most commonly arranged for medical indications which have developed before or during the pregnancy, and ideally after 39 weeks of gestation. In the UK, this is classified as a 'grade 4' section (delivery timed to suit the mother or hospital staff) or as a 'grade 3' section (no maternal or fetal compromise but early delivery needed). Emergency caesarean sections are performed in pregnancies in which a vaginal delivery was planned initially, but an indication for caesarean delivery has since developed. In the UK they are further classified as grade 2 (delivery required within 90 minutes of the decision but no immediate threat to the life of the woman or the fetus) or grade 1 (delivery required within 30 minutes of the decision: immediate threat to the life of the mother or the baby or both.) Elective caesarean sections may be performed based on an obstetrical or medical indication, or because of a medically non-indicated maternal request. Among women in the United Kingdom, Sweden, and Australia, about 7% preferred caesarean section as a method of delivery. In cases without medical indications the American Congress of Obstetricians and Gynecologists and the UK Royal College of Obstetricians and Gynaecologists recommend a planned vaginal delivery. The

National Institute for Health and Care Excellence The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care (United Kingdom), Department of Health and Social Care. As the national health technolog ...

recommends that if after a woman has been provided information on the risk of a planned caesarean section and she still insists on the procedure it should be provided. If provided this should be done at 39 weeks of gestation or later. There is no evidence that ECS can reduce mother-to-child

hepatitis B Hepatitis B is an infectious disease caused by the '' hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no symptoms during an initial infection. ...

and

hepatitis C virus The hepatitis C virus (HCV) is a small (55–65 nm in size), enveloped, positive-sense single-stranded RNA virus of the family ''Flaviviridae''. The hepatitis C virus is the cause of hepatitis C and some cancers such as liver cancer ( hepatoc ...

transmission.

By characteristics of the mother

Caesarean delivery on maternal request

Caesarean delivery on maternal request (CDMR) is a medically unnecessary caesarean section, where the conduct of a

childbirth Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy, where one or more Fetus, fetuses exits the Womb, internal environment of the mother via vaginal delivery or caesarean section and becomes a newborn to ...

via a caesarean section is requested by the

pregnant Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

patient even though there is not a medical indication to have the surgery. Systematic reviews have found no strong evidence about the impact of caesareans for nonmedical reasons. Recommendations encourage counseling to identify the reasons for the request, addressing anxieties and information, and encouraging vaginal birth. Elective caesareans at 38 weeks in some studies showed increased health complications in the newborn. For this reason ACOG and

NICE Nice ( ; ) is a city in and the prefecture of the Alpes-Maritimes department in France. The Nice agglomeration extends far beyond the administrative city limits, with a population of nearly one million Planned caesarean sections may be scheduled earlier if there is a medical reason.

After previous caesarean

Mothers who have previously had a caesarean section are more likely to have a caesarean section for future pregnancies than mothers who have never had a caesarean section. There is a discussion about the circumstances under which women should have a vaginal birth after a previous caesarean. Vaginal birth after caesarean (VBAC) is the practice of birthing a baby vaginally after a previous baby has been delivered by caesarean section (surgically). According to the American College of Obstetricians and Gynecologists (ACOG), successful VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. According to the American Pregnancy Association, 90% of women who have undergone caesarean deliveries are candidates for VBAC. Approximately 60–80% of women opting for VBAC will successfully give birth vaginally, which is comparable to the overall vaginal delivery rate in the United States in 2010.

Twins

For otherwise healthy twin pregnancies where both twins are head down a trial of vaginal delivery is recommended between 37 and 38 weeks. Vaginal delivery in this case does not worsen the outcome for either infant as compared with caesarean section. There is controversy on the best method of delivery where the first twin is head first and the second is not. When the first twin is not head down at the point of labor starting, a caesarean section should be recommended. Although the second twin typically has a higher frequency of problems, it is unknown if a planned caesarean section affects this. It is estimated that 75% of twin pregnancies in the United States were delivered by caesarean section in 2008.

Breech birth

A breech birth is the birth of a baby from a breech

presentation A presentation conveys information from a speaker to an audience. Presentations are typically demonstrations, introduction, lecture, or speech meant to inform, persuade, inspire, motivate, build goodwill, or present a new idea/product. Presenta ...

, in which the baby exits the pelvis with the

buttocks The buttocks (: buttock) are two rounded portions of the exterior anatomy of most mammals, located on the posterior of the pelvic region. In humans, the buttocks are located between the lower back and the perineum. They are composed of a lay ...

feet The foot (: feet) is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is an organ at the terminal part of the leg made up of ...

first as opposed to the normal head-first presentation. In breech presentation, fetal heart sounds are heard just above the umbilicus. Babies are usually born head first. If the baby is in another position the birth may be complicated. In a 'breech presentation', the unborn baby is bottom-down instead of head-down. Babies born bottom-first are more likely to be harmed during a normal (vaginal) birth than those born head-first. For instance, the baby might not get enough oxygen during the birth. Having a planned caesarean may reduce these problems. A review looking at planned caesarean section for singleton breech presentation with planned vaginal birth, concludes that in the short term, births with a planned caesarean were safer for babies than vaginal births. Fewer babies died or were seriously hurt when they were born by caesarean. There was tentative evidence that children who were born by caesarean had more health problems at age two. Caesareans caused some short-term problems for mothers such as more abdominal pain. They also had some benefits, such as less urinary incontinence and less perineal pain. The bottom-down position presents some hazards to the baby during the process of birth, and the mode of delivery (vaginal versus caesarean) is controversial in the fields of

obstetrics Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a su ...

and

midwifery Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period (including care of the newborn), in addition to the sexual and reproductive health of women throughout their lives. In many cou ...

. Though vaginal

birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as parturition. In mammals, the process is initiated by hormones which cause the muscular walls of the uterus to contract, expelling the f ...

is possible for the breech baby, certain fetal and maternal factors influence the safety of vaginal breech birth. The majority of breech babies born in the United States and the UK are delivered by caesarean section as studies have shown increased risks of morbidity and mortality for vaginal breech delivery, and most obstetricians counsel against planned vaginal breech birth for this reason. As a result of reduced numbers of actual vaginal breech deliveries, obstetricians and midwives are at risk of de-skilling in this important skill. All those involved in delivery of obstetric and midwifery care in the UK undergo mandatory training in conducting breech deliveries in the simulation environment (using dummy pelvises and mannequins to allow the practice of this important skill) and this training is carried out regularly to keep skills up to date.

Resuscitative hysterotomy

A resuscitative hysterotomy, also known as a peri-mortem caesarean delivery, is an emergency caesarean delivery carried out where maternal

cardiac arrest Cardiac arrest (also known as sudden cardiac arrest CA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly Circulatory system, circulate around the body and the blood flow to the ...

has occurred, to assist in

resuscitation Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an Acute (medicine), acutely ill patient. It is an important part of intensive care medicine, anesthesiology, trauma surgery and emerg ...

of the mother by removing the aortocaval compression generated by the gravid uterus. Unlike other forms of caesarean section, the welfare of the fetus is a secondary priority only, and the procedure may be performed even before the limit of

fetal viability Fetal viability is the ability of a human fetus to survive outside the uterus. Viability depends upon factors such as birth weight, gestational age, and the availability of advanced medical care. In low-income countries, more than 90% of extr ...

if it is judged to be of benefit to the mother.

Other ways, including the surgery technique

There are several types of caesarean section (CS). An important distinction lies in the type of incision (longitudinal or transverse) made on the

, apart from the incision on the skin: the vast majority of skin incisions are a transverse suprapubic approach known as a Pfannenstiel incision but there is no way of knowing from the skin scar which way the uterine incision was conducted. * The classical caesarean section involves a longitudinal midline incision on the uterus which allows a larger space to deliver the baby. It is performed at very early gestations where the lower segment of the uterus is unformed as it is safer in this situation for the baby: but it is rarely performed other than at these early gestations, as the operation is more prone to complications than a low transverse uterine incision. Any woman who has had a classical section will be recommended to have an elective repeat section in subsequent pregnancies as the vertical incision is much more likely to rupture in labor than the transverse incision. * The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the

. It results in less

blood loss Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...

and has fewer early and late complications for the mother, as well as allowing her to consider a vaginal birth in the next pregnancy. * A caesarean

hysterectomy Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes ( salpi ...

consists of a caesarean section followed by the removal of the

. This may be done in cases of intractable bleeding or when the

cannot be separated from the uterus. The EXIT procedure is a specialized surgical delivery procedure used to deliver babies who have airway compression. The Misgav Ladach method is a modified caesarean section that has been used nearly globally since the 1990s. It was described by Michael Stark, the president of the New European Surgical Academy, at the time he was the director of Misgav Ladach, a general hospital in Jerusalem. The method was presented during a FIGO conference in Montréal in 1994 and then distributed by the University of Uppsala, Sweden, in more than 100 countries. This method is based on minimalistic principles. He examined all steps in caesarean sections in use, analyzed them for their necessity, and, if found necessary, for their optimal performance. For the abdominal incision, he used the modified Joel Cohen incision and compared the longitudinal abdominal structures to strings on musical instruments. As blood vessels and muscles have lateral sway, it is possible to stretch rather than cut them. The peritoneum is opened by repeat stretching, no abdominal swabs are used, the uterus is closed in one layer with a big needle to reduce the amount of foreign body as much as possible, the peritoneal layers remain unsutured and the abdomen is closed with two layers only. Women undergoing this operation recover quickly and can look after the newborns soon after surgery. Many publications are showing the advantages over traditional caesarean section methods. There is also an increased risk of abruptio placentae and uterine rupture in subsequent pregnancies for women who underwent this method in prior deliveries. Since 2015, the

has endorsed the Robson classification as a holistic means of comparing childbirth rates between different settings, to allow more accurate comparison of caesarean section rates.

Technique

Antibiotic prophylaxis Antibiotic prophylaxis refers to, for humans, the prevention of infection complications using antimicrobial therapy (most commonly antibiotics). Antibiotic prophylaxis in domestic animal feed mixes has been employed in America since at least 1970 ...

is used before an incision. The

is incised, and this incision is extended with blunt pressure along a cephalad-caudad axis. The infant is delivered, and the

is then removed. The surgeon then decides about uterine exteriorization. Single-layer uterine closure is used when the mother does not want a future pregnancy. When subcutaneous tissue is 2 cm thick or more,

surgical suture A surgical suture, also known as a stitch or stitches, is a medical device used to hold Tissue (biology), body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a Sewing needle, needle w ...

is used. Discouraged practices include manual

cervical dilation Cervical dilation (or cervical dilatation) is the opening of the cervix, the entrance to the uterus, during childbirth, miscarriage, induced abortion, or gynecological surgery. Cervical dilation may occur naturally, or may be induced surgically ...

, any subcutaneous drain, or supplemental

oxygen therapy Oxygen therapy, also referred to as supplemental oxygen, is the use of oxygen as medical treatment. Supplemental oxygen can also refer to the use of oxygen enriched air at altitude. Acute indications for therapy include hypoxemia (low blood o ...

with intent to prevent infection. Caesarean section can be performed with single or double layer suturing of the uterine incision. Single layer closure compared with double layer closure has been observed to result in reduced blood loss during the surgery. It is uncertain whether this is the direct effect of the suturing technique or if other factors such as the type and site of abdominal incision contribute to reduced blood loss. Standard procedure includes the closure of the

peritoneum The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesotheli ...

. Research questions whether this is needed, with some studies indicating peritoneal closure is associated with longer operative time and hospital stay. The Misgav Ladach method is a surgery technical that may have fewer secondary complications and faster healing, due to the insertion into the muscle.

Anesthesia

Both

general A general officer is an Officer (armed forces), officer of high rank in the army, armies, and in some nations' air force, air and space forces, marines or naval infantry. In some usages, the term "general officer" refers to a rank above colone ...

and

regional anaesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, i.e. local insensitivity to pain, although other local senses may be affected as well. It all ...

( spinal,

epidural Epidural administration (from Ancient Greek ἐπί, "upon" + '' dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians ...

or combined spinal and epidural anaesthesia) are acceptable for use during caesarean section. Evidence does not show a difference between regional anaesthesia and general anaesthesia concerning major outcomes in the mother or baby. Regional anaesthesia may be preferred as it allows the mother to be awake and interact immediately with her baby. Compared to general anaesthesia, regional anaesthesia is better at preventing persistent postoperative pain 3 to 8 months after caesarean section. Other advantages of regional anesthesia may include the absence of typical risks of general anesthesia:

pulmonary aspiration Pulmonary aspiration is the entry of solid or liquid material such as pharyngeal secretions, food, drink, or stomach contents from the oropharynx or gastrointestinal tract, into the trachea and lungs. When pulmonary aspiration occurs during ea ...

(which has a relatively high incidence in patients undergoing anesthesia in late pregnancy) of gastric contents and esophageal

intubation Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Most commonly, intubation refers to tracheal intubation, a procedure during which an endotracheal tube is inserted into the trachea to supp ...

. One trial found no difference in satisfaction when general anaesthesia was compared with either spinal anaesthesia. Regional anaesthesia is used in 95% of deliveries, with spinal and combined spinal and epidural anaesthesia being the most commonly used regional techniques in scheduled caesarean section. Regional anaesthesia during caesarean section is different from the

analgesia Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals ...

(pain relief) used in labor and vaginal delivery. The pain that is experienced because of surgery is greater than that of labor and therefore requires a more intense

nerve block Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. #Local anesthetic nerve block, Local anesthetic nerve block (sometimes referred to as simply "nerve b ...

. General anesthesia may be necessary because of specific risks to the mother or child. Patients with heavy, uncontrolled bleeding may not tolerate the hemodynamic effects of regional anesthesia. General anesthesia is also preferred in very urgent cases, such as severe fetal distress when there is no time to perform a regional anesthesia.

Prevention of complications

Postpartum infection is one of the main causes of maternal death and may account for 10% of maternal deaths globally. A caesarean section greatly increases the risk of infection and associated morbidity, estimated to be between 5 and 20 times as high, and routine use of antibiotic prophylaxis to prevent infections was found by a

meta-analysis Meta-analysis is a method of synthesis of quantitative data from multiple independent studies addressing a common research question. An important part of this method involves computing a combined effect size across all of the studies. As such, th ...

to substantially reduce the incidence of febrile morbidity. Infection can occur in around 8% of women who have caesareans, largely endometritis,

urinary tract infections A urinary tract infection (UTI) is an infection that affects a part of the urinary tract. Lower urinary tract infections may involve the bladder (cystitis) or urethra ( urethritis) while upper urinary tract infections affect the kidney (pye ...

and wound infections. Preventative antibiotics in women undergoing caesarean section decreased wound infection, endometritis, and serious infectious complications by about 65%. Side effects and effects on the baby are unclear. Women who have caesareans can recognize the signs of fever that indicate the possibility of wound infection. Taking antibiotics before skin incision rather than after cord clamping reduces the risk for the mother, without increasing adverse effects for the baby. Moderate certainty evidence suggests that

chlorhexidine gluconate Chlorhexidine is a disinfectant and antiseptic which is used for skin disinfection before surgery and to disinfect surgical instruments. It is also used for cleaning wounds, preventing dental plaque, treating yeast infections of the mouth, ...

as a skin preparation is slightly more effective in the prevention of surgical site infections than povidone-iodine but further research is needed. Some doctors believe that during a caesarean section, mechanical

with a finger or forceps will prevent the obstruction of blood and lochia drainage, and thereby benefit the mother by reducing the risk of death. The evidence neither supported nor refuted this practice for reducing postoperative morbidity, pending further large studies.

Hypotension Hypotension, also known as low blood pressure, is a cardiovascular condition characterized by abnormally reduced blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood and is ...

(low blood pressure) is common in women who have spinal anaesthesia; intravenous fluids such as crystalloids, or compressing the legs with bandages, stockings, or inflatable devices may help to reduce the risk of hypotension but the evidence is still uncertain about their effectiveness.

Skin-to-skin contact

The

WHO The World Health Organization (WHO) is a specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Geneva, Switzerland, and has 6 regional offices and 15 ...

and

UNICEF UNICEF ( ), originally the United Nations International Children's Emergency Fund, officially United Nations Children's Fund since 1953, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Development a ...

recommend that infants born by Caesarean section should have skin-to-skin contact (SSC) as soon as the mother is alert and responsive. Immediate SSC following a spinal or epidural anesthetic is possible because the mother remains alert; however, after a general anaesthetic, the father or other family member may provide SSC until the mother is able. It is known that during the hours of labor before a vaginal birth, a woman's body begins to produce

oxytocin Oxytocin is a peptide hormone and neuropeptide normally produced in the hypothalamus and released by the posterior pituitary. Present in animals since early stages of evolution, in humans it plays roles in behavior that include Human bonding, ...

which aids in the bonding process, and it is thought that SSC can trigger its production as well. Indeed, women have reported that they felt that SSC had helped them to feel close to and bond with their infant. A review of literature also found that immediate or early SSC increased the likelihood of successful breastfeeding and that newborns were found to cry less and relax quicker when they had SSC with their father as well.

Recovery

It is common for women who undergo caesarean section to have reduced or absent bowel movements for hours to days. During this time, women may experience abdominal cramps, nausea, and vomiting. This usually resolves without treatment. Poorly controlled pain following non-emergent caesarean section occurs in between 13% and 78% of women. Following caesarean delivery, complementary and alternative therapies (e.g.,

acupuncture Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine (TCM) in which thin needles are inserted into the body. Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientif ...

) may help to relieve pain, though evidence supporting the efficacy of such treatments is extremely limited. Abdominal, wound, and back pain can continue for months after a caesarean section. Non-steroidal anti-inflammatory drugs can be helpful. For the first couple of weeks after a caesarean, women should avoid lifting anything heavier than their baby. To minimize pain during breastfeeding, women should experiment with different breastfeeding holds including the football hold and side-lying hold. Women who have had a caesarean are more likely to experience pain that interferes with their usual activities than women who have vaginal births, although by six months there is generally no longer a difference. Pain during sexual intercourse is less likely than after vaginal birth; by six months there is no difference. There may be a somewhat higher incidence of postnatal depression in the first weeks after childbirth for women who have caesarean sections, but this difference does not persist. Some women who have had caesarean sections, especially emergency caesareans, experience

post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a Psychological trauma, traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster ...

. A woman who undergoes caesarean section has 18.3% chance of chronic surgical pain at three months and 6.8% chance of surgical pain at 12 months. In recent meta-analyses, caesarean section has been associated with a lower risk of urinary incontinence and pelvic organ prolapse compared to vaginal delivery. Women who have vaginal births, after a previous caesarean, are more than twice as likely to subsequently have pelvic floor surgery as those who have another caesarean.

Frequency

Global rates of caesarean section are increasing. It doubled from 2003 to 2018 to reach 21%, and is increasing annually by 4%. The trend toward increasing rates is particularly strong in the middle and high-income countries. In southern Africa, the cesarean rate is less than 5%; while the rate is almost 60% in some parts of Latin America. The Canadian rate was 26% in 2005–2006. Australia has a high caesarean section rate, at 31% in 2007. At one time a rate of 10% to 15% was thought to be ideal; a rate of 19% may result in better outcomes. The World Health Organization officially withdrew its previous recommendation of a 15% C-section rate in June 2010. Their official statement read, "There is no empirical evidence for an optimum percentage. What matters most is that all women who need caesarean sections receive them." More than 50 nations have rates greater than 27%. Another 45 countries have rates of less than 7.5%. There are efforts to both improve access to and reduce the use of C-sections. Globally, 1% of all caesarean deliveries are carried out without medical need. Overall, the caesarean section rate was 25.7% for 2004–2008. There is no significant difference in caesarean rates when comparing midwife continuity care to conventional fragmented care. More emergency caesareans—about 66%—are performed during the day rather than the night. The rate has risen to 46% in

China China, officially the People's Republic of China (PRC), is a country in East Asia. With population of China, a population exceeding 1.4 billion, it is the list of countries by population (United Nations), second-most populous country after ...

and to levels of 25% and above in many Asian, European and Latin American countries. In Brazil and Iran the caesarean section rate is greater than 40%. Brazil has one of the highest caesarean section rates in the world, with rates in the public sector of 35–45%, and 80–90% in the private sector.

Europe

Across Europe, there are differences between countries: in Italy, the caesarean section rate is 40%, while in the

Nordic countries The Nordic countries (also known as the Nordics or ''Norden''; ) are a geographical and cultural region in Northern Europe, as well as the Arctic Ocean, Arctic and Atlantic Ocean, North Atlantic oceans. It includes the sovereign states of Denm ...

it is 14%. In the United Kingdom, in 2008, the rate was 24%. In Ireland the rate was 26.1% in 2009. In Italy, the incidence of caesarean sections is particularly high, although it varies from region to region. In

Campania Campania is an administrative Regions of Italy, region of Italy located in Southern Italy; most of it is in the south-western portion of the Italian Peninsula (with the Tyrrhenian Sea to its west), but it also includes the small Phlegraean Islan ...

, 60% of 2008 births reportedly occurred via caesarean sections. In the

Rome Rome (Italian language, Italian and , ) is the capital city and most populated (municipality) of Italy. It is also the administrative centre of the Lazio Regions of Italy, region and of the Metropolitan City of Rome. A special named with 2, ...

region, the mean incidence is around 44%, but can reach as high as 85% in some private clinics.

United States

In the United States, cesarean deliveries began rising in the 1960s and started becoming routine in the 1960s and 1970s. In the United States, the rate of C-sections is around 33%, varying from 23% to 40% depending on the state. One of three women who gave birth in the US delivered by caesarean in 2011. In 2012, close to 23 million C-sections were carried out globally. With nearly 1.3 million stays, caesarean section was one of the most common procedures performed in U.S. hospitals in 2011. It was the second-most common procedure performed for people ages 18 to 44 years old. Caesarean rates in the U.S. have risen considerably since 1996. The rate has increased in the United States, to 33% of all births in 2012, up from 21% in 1996. In 2010, the caesarean delivery rate was 32.8% of all births (a slight decrease from 2009's high of 32.9% of all births). A study found that in 2011, women covered by private insurance were 11% more likely to have a caesarean section delivery than those covered by Medicaid. The increase in use has not resulted in improved outcomes, resulting in the position that C-sections may be done too frequently. It is believed that the high rate of induced deliveries has also led to the high rate of c-sections because they are twice as likely to lead to one. Hospitals and doctors make more money from C-section births than vaginal deliveries. Economists have calculated that hospitals may make a few thousand dollars more and doctors a few hundred. It has been found that for-profit hospitals do more c-sections than non-profit hospitals. One study looked at the rate of c-sections done for women who were themselves doctors. It found that there was a 10 percent decrease in the rate of c-sections vs the general population. But if the hospital paid their doctors a flat salary removing the incentive to do the surgical procedures, which take more time, the rate of c-sections done on women who were themselves physicians exceeded that of the procedure done on non-medically knowledgeable mothers, suggesting that some women who needed c-sections were not getting them. Concerned over the rising number of cesarean deliveries and hospital costs, in 2009

Minnesota Minnesota ( ) is a U.S. state, state in the Upper Midwestern region of the United States. It is bordered by the Canadian provinces of Manitoba and Ontario to the north and east and by the U.S. states of Wisconsin to the east, Iowa to the so ...

introduced a blended payment rate for either vaginal or cesarean uncomplicated births (i.e., a similar payment regardless of delivery mode). As a result, the prepolicy cesarean rate of 22.8% dropped by 3.24 percentage points. The cost of childbirth hospitalizations in Minnesota dropped by $425.80 at the time the policy was initiated and continued to drop by $95.04 per quarter with no significant effects on maternal morbidity. The rise of cesarean births in the United States has coincided with counter-movements emphasizing natural childbirth with a lesser degree of medical intervention.

China

The rate of cesarean sections began to sharply increase in China in the 1990s. This increase was driven by the expansion of China's modern hospital infrastructure, and occurred first in urban areas. The rise in cesarean deliveries has also resulted in social critique of the medical establishment over the medical necessity of performing cesarean sections.

History

There are many conflicting stories of the first successful caesarean section in which both mother and baby survived. It is, however, known that the procedure had been attempted for hundreds of years before it became accepted at the beginning of the twentieth century. While forceps have gone through periods of high popularity, today they are only used in approximately 10% of deliveries. The C-section has become the more popular solution for difficult deliveries. In 2005, one-third of babies were born via C-section. Historically, caesarean sections performed upon a live woman usually resulted in the death of the mother. It was considered an extreme measure, performed only when the mother was already dead or considered to be beyond help. By way of comparison, see the resuscitative hysterotomy or perimortem caesarean section. According to the ancient Chinese ''

Records of the Grand Historian The ''Shiji'', also known as ''Records of the Grand Historian'' or ''The Grand Scribe's Records'', is a Chinese historical text that is the first of the Twenty-Four Histories of imperial China. It was written during the late 2nd and early 1st ce ...

'', Luzhong (), a sixth-generation descendant of the mythical

Yellow Emperor The Yellow Emperor, also known as the Yellow Thearch, or Huangdi ( zh, t=黃帝, s=黄帝, first=t) in Chinese, is a mythical Chinese sovereign and culture hero included among the legendary Three Sovereigns and Five Emperors. He is revered as ...

, had six sons, all born by "cutting open the body". The sixth son

Jilian Jilian () was the first recorded ruler of the ancient Chinese state that was later known as Chu. He adopted the clan name Mi () and was the founder of the House of Mi that ruled Chu for over eight centuries. Ancestry According to legends record ...

founded the House of Mi that ruled the

State of Chu Chu (, Old Chinese: ''*s-r̥aʔ'') was an Ancient Chinese states, ancient Chinese state during the Zhou dynasty. Their first ruler was King Wu of Chu in the early 8th century BC. Chu was located in the south of the Zhou heartland and lasted ...

(–223 BC). The

Sanskrit Sanskrit (; stem form ; nominal singular , ,) is a classical language belonging to the Indo-Aryan languages, Indo-Aryan branch of the Indo-European languages. It arose in northwest South Asia after its predecessor languages had Trans-cultural ...

medical treatise ''

Sushruta Samhita The ''Sushruta Samhita'' (, ) is an ancient Sanskrit text on medicine and one of the most important such treatises on this subject to survive from the ancient world. The ''Compendium of Sushruta, Suśruta'' is one of the foundational texts of ...

'', composed in the early 1st millennium CE, mentions post-mortem caesarean sections. The first available non-mythical record of a C-section is the mother of

Bindusara Bindusara (320 BCE – 273 BCE) () was the second Mauryan emperor of Magadha in Ancient India. The ancient Greco-Roman writers called him Amitrochates, a name likely derived from his Sanskrit title ''Amitraghāta'' ("slayer of enemies"). ...

(born , ruled 298 – ), the second

Mauryan The Maurya Empire was a geographically extensive Iron Age historical power in South Asia with its power base in Magadha. Founded by Chandragupta Maurya around c. 320 BCE, it existed in loose-knit fashion until 185 BCE. The primary sourc ...

''Samrat'' (

emperor The word ''emperor'' (from , via ) can mean the male ruler of an empire. ''Empress'', the female equivalent, may indicate an emperor's wife (empress consort), mother/grandmother (empress dowager/grand empress dowager), or a woman who rules ...

) of India, accidentally consumed poison and died when she was close to delivering him.

Chanakya Chanakya (ISO 15919, ISO: ', चाणक्य, ), according to legendary narratives preserved in various traditions dating from the 4th to 11th century CE, was a Brahmin who assisted the first Mauryan emperor Chandragupta Maurya, Chandragup ...

, Chandragupta's teacher and adviser, 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. An early account of caesarean section in Iran (Persia) is mentioned in the book of ''

Shahnameh The ''Shahnameh'' (, ), also transliterated ''Shahnama'', is a long epic poem written by the Persian literature, Persian poet Ferdowsi between and 1010 CE and is the national epic of Greater Iran. Consisting of some 50,000 distichs or couple ...

'', written around 1000 AD, and relates to the birth of

Rostam use both this parameter and , birth_date to display the person's date of birth, date of death, and age at death) --> , death_place = Kabulistan , death_cause = With the conspiracy of his half-brother Shaghad, he fell into a we ...

, the legendary hero of that country. According to the ''Shahnameh'', the

Simurgh The simurgh (; ; also spelled ''senmurv, simorgh, simorg'', ''simurg'', ''simoorg, simorq'' or ''simourv'') is a benevolent bird in Persian mythology and Persian literature, literature. It bears some similarities with mythological birds from di ...

instructed Zal upon how to perform a caesarean section, thus saving Rudaba and the child Rostam. In Persian literature caesarean section is known as ''Rostamina'' (). In the Irish mythological text the

Ulster Cycle The Ulster Cycle (), formerly known as the Red Branch Cycle, is a body of medieval Irish heroic legends and sagas of the Ulaid. It is set far in the past, in what is now eastern Ulster and northern Leinster, particularly counties Armagh, Do ...

, the character

Furbaide Ferbend Furbaide Ferbend is a character from the Ulster Cycle of Irish mythology. Legend has it that Furbaide Ferbend was buried in a passage grave atop Carn Clonhugh, more commonly known as Corn Hill or Cairn Hill, north Longford, after the two passa ...

is said to have been born by posthumous caesarean section, after his mother was murdered by his evil aunt Medb. The

Babylonian Talmud The Talmud (; ) is the central text of Rabbinic Judaism and the primary source of Jewish religious law (''halakha'') and Jewish theology. Until the advent of modernity, in nearly all Jewish communities, the Talmud was the centerpiece of Jewi ...

, an ancient

Jew Jews (, , ), or the Jewish people, are an ethnoreligious group and nation, originating from the Israelites of ancient Israel and Judah. They also traditionally adhere to Judaism. Jewish ethnicity, religion, and community are highly inte ...

ish religious text, mentions a procedure similar to the caesarean section. The procedure is termed . It also discusses at length the permissibility of performing a C-section on a dying or dead mother.

Rabbi A rabbi (; ) is a spiritual leader or religious teacher in Judaism. One becomes a rabbi by being ordained by another rabbi—known as ''semikha''—following a course of study of Jewish history and texts such as the Talmud. The basic form of t ...

nical reports from the 2nd century AD about discussions that took place even earlier suggested that Jewish women regularly survived the operation in Roman times, but this conflicts with the general view that caesarean sections were always fatal to the mother in the pre-

modern era The modern era or the modern period is considered the current historical period of human history. It was originally applied to the history of Europe and Western history for events that came after the Middle Ages, often from around the year 1500 ...

Pliny the Elder Gaius Plinius Secundus (AD 23/24 79), known in English as Pliny the Elder ( ), was a Roman Empire, Roman author, Natural history, naturalist, and naval and army commander of the early Roman Empire, and a friend of the Roman emperor, emperor Vesp ...

theorized that Julius Caesar's (born 100 BC) name came from an ancestor who was born by caesarean section, but the truth of this is debated (see the discussion of the etymology of ''Caesar''). Some popular misconceptions involve Caesar himself being born from the procedure; which is considered false because the procedure was lethal to mothers in ancient Rome and Caesar's mother Aurelia Cotta lived until he was an adult. The Ancient Roman caesarean section was first performed to remove a baby from the womb of a mother who died during childbirth, a practice sometimes called the ''Caesarean law''. The Spanish saint

Raymond Nonnatus Raymond Nonnatus, Order of the Blessed Virgin Mary of Mercy, O. de M. (, , , ), (1204 – 31 August 1240) is a saint from Catalonia in Spain. His nickname (, "not born") refers to his birth by Caesarean section, his mother having died while givin ...

(1204–1240) received his surname—from the

Latin Latin ( or ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken by the Latins (Italic tribe), Latins in Latium (now known as Lazio), the lower Tiber area aroun ...

('not born')—because he was born by caesarean section. His mother died while giving birth to him. There is some indirect evidence that the first caesarean section that was survived by both the mother and child was performed in

Prague Prague ( ; ) is the capital and List of cities and towns in the Czech Republic, largest city of the Czech Republic and the historical capital of Bohemia. Prague, located on the Vltava River, has a population of about 1.4 million, while its P ...

in 1337. The mother was Beatrice of Bourbon, the second wife of the King of Bohemia John of Luxembourg. Beatrice gave birth to the king's son Wenceslaus I, later the Duke of Luxembourg, Brabant, and Limburg, and who became the half brother of the later King of Bohemia and Holy Roman Emperor, Charles IV. In an account from the 1580s, Jakob Nufer, a

veterinarian A veterinarian (vet) or veterinary surgeon is a medical professional who practices veterinary medicine. They manage a wide range of health conditions and injuries in non-human animals. Along with this, veterinarians also play a role in animal r ...

in Siegershausen, Switzerland, is supposed to have operated on his wife after a prolonged labour, with her surviving. His wife allegedly bore five more children, including twins, and the baby delivered by caesarean section purportedly lived to the age of 77. For most of the time since the 16th century, the procedure had a high mortality rate by modern standards. Key steps in reducing mortality were: * Introduction of the transverse incision technique to minimize bleeding by Ferdinand Adolf Kehrer in 1881 is thought to be the first modern CS performed. * The introduction of uterine

suturing A surgical suture, also known as a stitch or stitches, is a medical device used to hold Tissue (biology), body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a Sewing needle, needle w ...

by Max Sänger in 1882 * Modification by Hermann Johannes Pfannenstiel in 1900, see Pfannenstiel incision * Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912) * Adherence to principles of

asepsis Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...

Anesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...

advances *

Blood transfusion Blood transfusion is the process of transferring blood products into a person's Circulatory system, circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used ...

Antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

s Indigenous people in the

Great Lakes region The Great Lakes region of Northern America is a binational Canadian– American region centered on the Great Lakes that includes the U.S. states of Illinois, Indiana, Michigan, Minnesota, New York, Ohio, Pennsylvania, and Wisconsin and the Ca ...

of Africa, including

Rwanda Rwanda, officially the Republic of Rwanda, is a landlocked country in the Great Rift Valley of East Africa, where the African Great Lakes region and Southeast Africa converge. Located a few degrees south of the Equator, Rwanda is bordered by ...

and

Uganda Uganda, officially the Republic of Uganda, is a landlocked country in East Africa. It is bordered to the east by Kenya, to the north by South Sudan, to the west by the Democratic Republic of the Congo, to the south-west by Rwanda, and to the ...

, performed caesarean sections which in one account by

Robert William Felkin Robert William Felkin FRSE LRCSE LRCP (13 March 1853 – 28 December 1926) was a British medical missionary and explorer, a ceremonial magician, member of the S.R.I.A, member of the Hermetic Order of the Golden Dawn, a prolific author on Ugan ...

from 1879 resulted in the survival of both mother and child. Banana wine was used, although the site of the incision was then also washed with water and, post-operation, covered with a paste made by chewing two different roots. From the well-developed nature of the medical procedures employed he concluded that these procedures had been employed for some time. James Barry was the first European doctor to carry out a successful caesarean in Africa, while posted to Cape Town between 1817 and 1828. The first successful caesarean section to be performed in the United States took place in Rockingham County, Virginia in 1794. The procedure was performed by Dr. Jesse Bennett on his wife Elizabeth.

Caesarius of Terracina

The

patron saint A patron saint, patroness saint, patron hallow or heavenly protector is a saint who in Catholicism, Anglicanism, Eastern Orthodoxy or Oriental Orthodoxy is regarded as the heavenly advocate of a nation, place, craft, activity, class, clan, fa ...

of caesarean section is Caesarius, a young deacon martyred at Terracina, who has replaced and Christianized the pagan figure of

Caesar Gaius Julius Caesar (12 or 13 July 100 BC – 15 March 44 BC) was a Roman general and statesman. A member of the First Triumvirate, Caesar led the Roman armies in the Gallic Wars before defeating his political rival Pompey in a civil war. He ...

. The martyr (Saint Cesareo in Italian) is invoked for the success of this surgical procedure, because it was considered the new "Christian Caesar" – as opposed to the "pagan Caesar" – in the Middle Ages it began to be invoked by pregnant women to wish a physiological birth, for the success of the expulsion of the baby from the uterus and, therefore, for their salvation and that of the unborn. The practice continues, in fact, the martyr Caesarius is invoked by the future mothers who, due to health problems or that of the baby, must give birth to their child by caesarean section.

Etymology

The origin of the term is not definitively known. Roman '' Lex Regia'' (royal law), later the (imperial law), of

Numa Pompilius Numa Pompilius (; 753–672 BC; reigned 715–672 BC) was the Roman mythology, legendary second king of Rome, succeeding Romulus after a one-year interregnum. He was of Sabine origin, and many of Rome's most important religious and political ins ...

(715–673 BC), required the child of a mother who had died during childbirth to be cut from her womb. There was a cultural

taboo A taboo is a social group's ban, prohibition or avoidance of something (usually an utterance or behavior) based on the group's sense that it is excessively repulsive, offensive, sacred or allowed only for certain people.''Encyclopædia Britannica ...

that mothers should not be buried pregnant, that may have reflected a way of saving some fetuses. Roman practice required a living mother to be in her tenth month of pregnancy before resorting to the procedure, reflecting the knowledge that she could not survive the delivery. Speculations that the Roman dictator

was born by the method now known as C-section are false. Although caesarean sections were performed in Roman times, no classical source records a mother surviving such a delivery, while Caesar's mother lived for years after his birth. As late as the 12th century, scholar and physician

Maimonides Moses ben Maimon (1138–1204), commonly known as Maimonides (, ) and also referred to by the Hebrew acronym Rambam (), was a Sephardic rabbi and Jewish philosophy, philosopher who became one of the most prolific and influential Torah schola ...

expresses doubt over the possibility of a woman's surviving this procedure and again becoming pregnant. The term has also been explained as deriving from the verb '' caedere'', 'to cut', with children delivered this way referred to as .

refers to a certain Julius Caesar (an ancestor of the famous Roman statesman) as , 'cut from the womb' giving this as an explanation for the

cognomen A ''cognomen'' (; : ''cognomina''; from ''co-'' "together with" and ''(g)nomen'' "name") was the third name of a citizen of ancient Rome, under Roman naming conventions. Initially, it was a nickname, but lost that purpose when it became hereditar ...

''Caesar'' which was then carried by his descendants. Nonetheless, the

false etymology A false etymology (fake etymology or pseudo-etymology) is a false theory about the origin or derivation of a specific word or phrase. When a false etymology becomes a popular belief in a cultural/linguistic community, it is a folk etymology (or po ...

has been widely repeated until recently. For example, the first (1888) and second (1989) editions of the ''

Oxford English Dictionary The ''Oxford English Dictionary'' (''OED'') is the principal historical dictionary of the English language, published by Oxford University Press (OUP), a University of Oxford publishing house. The dictionary, which published its first editio ...

'' say that caesarean birth "was done in the case of Julius Cæsar". More recent dictionaries are more diffident: the online edition of the OED (2021) mentions "the traditional belief that Julius Cæsar was delivered this way", and ''Merriam-Webster's Collegiate Dictionary'' (2003) says "from the legendary association of such a delivery with the Roman cognomen ''Caesar''". The word ''Caesar'', meaning either Julius Caesar or an emperor in general, is also borrowed or

calque In linguistics, a calque () or loan translation is a word or phrase borrowed from another language by literal word-for-word or root-for-root translation. When used as a verb, "to calque" means to borrow a word or phrase from another language ...

d in the name of the procedure in many other languages in Europe and beyond. Finally, the Roman ''

praenomen The praenomen (; plural: praenomina) was a first name chosen by the parents of a Ancient Rome, Roman child. It was first bestowed on the ''dies lustricus'' (day of lustration), the eighth day after the birth of a girl, or the ninth day after the ...

'' (given name) Caeso was said to be given to children who were born via C-section. While this was probably just

folk etymology Folk etymology – also known as (generative) popular etymology, analogical reformation, (morphological) reanalysis and etymological reinterpretation – is a change in a word or phrase resulting from the replacement of an unfamiliar form by a mo ...

made popular by Pliny the Elder, it was well known by the time the term came into common use.

Spelling

The term ''caesarean'' is spelled in various accepted ways, as discussed at Wiktionary. The

Medical Subject Headings Medical Subject Headings (MeSH) is a comprehensive controlled vocabulary for the purpose of indexing Academic journal, journal articles and books in the Life science, life sciences. It serves as a thesaurus of index terms that facilitates searc ...

(MeSH) of the

United States National Library of Medicine The United States National Library of Medicine (NLM), operated by the United States federal government, is the world's largest medical library. Located in Bethesda, Maryland, the NLM is an institute within the National Institutes of Health. I ...

(NLM) uses ''cesarean section'', while some other American medical works, e.g. ''Saunders Comprehensive Veterinary Dictionary'', use ''caesarean'', as do most British works. The online versions of the US-published ''Merriam-Webster Dictionary'' and ''American Heritage Dictionary'' list ''cesarean'' first and other spellings as "variants".

Society and culture

Court cases

'' In re A.C.'', 573 A.2d 1235 (1990), was a

District of Columbia Court of Appeals The District of Columbia Court of Appeals is the highest court of the District of Columbia, the capital city of the United States. The court was established in 1942 as the Municipal Court of Appeals, and it has been the court of last resort ...

case. It was the first American appellate court case decided against a forced Caesarean section, although the decision was issued after the fatal procedure was performed. Physicians performed a Caesarean section upon patient Angela Carder (née Stoner) without informed consent in an unsuccessful attempt to save the life of her baby. The case stands as a landmark in United States

case law Case law, also used interchangeably with common law, is a law that is based on precedents, that is the judicial decisions from previous cases, rather than law based on constitutions, statutes, or regulations. Case law uses the detailed facts of ...

establishing the

rights Rights are law, legal, social, or ethics, ethical principles of freedom or Entitlement (fair division), entitlement; that is, rights are the fundamental normative rules about what is allowed of people or owed to people according to some legal sy ...

of informed consent and bodily integrity for pregnant women. In Illinois, ''In re Baby Boy Doe'', 632 N.E.2d 326 (Ill. App. Ct. 1994) was a court case holding that courts may not balance whatever rights a fetus may have against the rights of a competent woman, whose choice to refuse medical treatment as invasive as a Cesarean section must be honored even if the choice may be harmful to the fetus. '' Pemberton v. Tallahassee Memorial Regional Center'', 66 F. Supp. 2d 1247 (N.D. Fla. 1999), is a case in the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

regarding

reproductive rights Reproductive rights are legal rights and freedoms relating to human reproduction, reproduction and reproductive health that vary amongst countries around the world. The World Health Organization defines reproductive rights: Reproductive rights ...

. Pemberton had a previous Caesarean section (vertical incision), and with her second child attempted to have a VBAC (vaginal birth after c-section). When a doctor she had approached about a related issue at the Tallahassee Memorial Regional Center found out, he and the hospital sued to force her to get a c-section. The court held that the rights of the fetus at or near birth outweighed the rights of Pemberton to determine her own medical care. She was physically forced to stop laboring, and taken to the hospital, where a c-section was performed. Her suit against the hospital was dismissed. The court held that a cesarean section at the end of a full-term pregnancy was here deemed to be medically necessary by doctors to avoid a substantial risk that the fetus would die during delivery due to uterine rupture, a risk of 4–6% according to the hospital's doctors and 2% according to Pemberton's doctors. Furthermore, the court held that a state's interest in preserving the life of an unborn child outweighed the mother's constitutional interest in bodily integrity. The court held that ''

Roe v. Wade ''Roe v. Wade'', 410 U.S. 113 (1973),. was a List of landmark court decisions in the United States, landmark decision of the U.S. Supreme Court in which the Court ruled that the Constitution of the United States protected the right to have an ...

'' was not applicable, because bearing an unwanted child is a greater intrusion on the mother's constitutional interests than undergoing a cesarean section to deliver a child that the mother affirmatively desires to deliver. The court further distinguished '' In re A.C.'' by stating that it left open the possibility that a non-consenting patient's interest would yield to a more compelling countervailing interest in an "extremely rare and truly exceptional case." The court then held this case to be such.

Presence of father

In many hospitals, the mother's partner is encouraged to attend the surgery to support her and share the experience. While traditionally there has been an opaque surgical drape obstructing the parents' view, some patients and doctors are opting for a "gentle C-section" using a clear drape, allowing the parents to watch the delivery and see their infant immediately.

Special cases

Judaism Judaism () is an Abrahamic religions, Abrahamic, Monotheism, monotheistic, ethnic religion that comprises the collective spiritual, cultural, and legal traditions of the Jews, Jewish people. Religious Jews regard Judaism as their means of o ...

, there is a dispute among the ''

poskim In Jewish law, a ''posek'' ( , pl. ''poskim'', ) is a legal scholar who determines the application of ''halakha'', the Jewish religious laws derived from the written and Oral Torah, in cases of Jewish law where previous authorities are inconc ...

'' (Rabbinic authorities) as to whether the first-born son from a caesarean section has the laws of a '' bechor''. Traditionally, a male child delivered by caesarean is not eligible for the ''

Pidyon HaBen The ''pidyon haben'' () or redemption of the first-born son is a mitzvah in Judaism whereby a Jewish firstborn son is "redeemed" with money. The redemption is attained by paying five silver coins to a kohen (a patrilineal descendant of the pr ...

'' dedication ritual. In rare cases, caesarean sections can be used to remove a dead

fetus A fetus or foetus (; : fetuses, foetuses, rarely feti or foeti) is the unborn offspring of a viviparous animal that develops from an embryo. Following the embryonic development, embryonic stage, the fetal stage of development takes place. Pren ...

; otherwise, the woman has to labour and deliver a baby known to be a

stillbirth Stillbirth is typically defined as fetus, fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without vital signs, signs of life. A stillbirth can often result in the feeling of guilt (emotio ...

. A late-term abortion using caesarean section procedures is termed a hysterotomy abortion and is very rarely performed. The mother may perform a caesarean section on herself; there have been successful cases, such as Inés Ramírez Pérez of Mexico who, on 5 March 2000, took this action. She survived, as did her son, Orlando Ruiz Ramírez. In 2024, a female

western lowland gorilla The western lowland gorilla (''Gorilla gorilla gorilla'') is one of two Critically Endangered subspecies of the western gorilla (''Gorilla gorilla'') that lives in Montane ecosystems#Montane forests, montane, Old-growth forest, primary and sec ...

had a successful cesarean section after zoo veterinarians diagnosed her with

. The premature gorilla infant survived, as a result of similar methods used with human infants.

References

{{DEFAULTSORT:Caesarean Section Wikipedia articles with sections published in WikiJournal of Medicine Obstetric surgery Childbirth

list A list is a Set (mathematics), set of discrete items of information collected and set forth in some format for utility, entertainment, or other purposes. A list may be memorialized in any number of ways, including existing only in the mind of t ...

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