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{{short description|Surgical procedure to deliver a baby through an incision in the mother’s abdomen}}{{cs1 config|name-list-style=vanc|display-authors=6}}{{Use dmy dates|date=December 2019}}

factoids

| ICD10 = 10D00Z074}}| MeshID = D002585| MedlinePlus = 002911| OPS301 =| OtherCodes =}}Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen. It is often performed because vaginal delivery would put the mother or child at risk.WEB, 1 February 2017, Pregnancy Labor and Birth,www.womenshealth.gov/pregnancy/childbirth-and-beyond/labor-and-birth, live,web.archive.org/web/20170728021055/https://www.womenshealth.gov/pregnancy/childbirth-and-beyond/labor-and-birth, 28 July 2017, 15 July 2017, Office on Women’s Health, U.S. Department of Health and Human Services, {{PD-notice}} Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother’s pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary.WEB, March 2014, Safe Prevention of the Primary Cesarean Delivery,www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2014/03/safe-prevention-of-the-primary-cesarean-delivery, 23 January 2022, American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, 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. A urinary catheter is used to drain the bladder, and the skin of the abdomen is then cleaned with an antiseptic. An incision of about 15 cm (6 inches) is then typically made through the mother’s lower abdomen. The uterus is then opened with a second incision and the baby delivered. The incisions are then stitched closed. A woman can typically begin breastfeeding as soon as she is out of the operating room and awake.BOOK, Lauwers J, Swisher A, Hospital Practices that Support Breast Feeding, Counseling the Nursing Mother: A Lactation Consultant’s Guide, 2010, Jones & Bartlett Publishers, 978-1-4496-1948-0, 274,books.google.com/books?id=2X0_Takcr_wC&pg=PA274, en, live,web.archive.org/web/20170911003217/https://books.google.com/books?id=2X0_Takcr_wC&pg=PA274, 11 September 2017, 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 longer to heal from, about six weeks, than vaginal birth. The increased risks include breathing problems in the baby and amniotic fluid embolism and postpartum bleeding in the mother. Established guidelines recommend that caesarean sections not be used before 39 weeks of pregnancy without a medical reason.{{Citation |author1 = American Congress of Obstetricians and Gynecologists |author1-link = American Congress of Obstetricians and Gynecologists |title = Five Things Physicians and Patients Should Question |publisher = American Congress of Obstetricians and Gynecologists |work = Choosing Wisely: an initiative of the ABIM Foundation |url =www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |access-date = 1 August 2013 |url-status = live |archive-url =www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/" title="web.archive.org/web/20130901094916www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/">web.archive.org/web/20130901094916www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |archive-date = 1 September 2013 }} The method of delivery does not appear to have an effect on subsequent sexual function.JOURNAL, Yeniel AO, Petri E, Pregnancy, childbirth, and sexual function: perceptions and facts, International Urogynecology Journal, 25, 1, 5–14, January 2014, 23812577, 10.1007/s00192-013-2118-7, 2638969, In 2012, about 23 million C-sections were done globally. The international healthcare community has previously considered the rate of 10% and 15% to be ideal for caesarean sections.WEB, WHO Statement on Caesarean Section Rates,apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf, 6 May 2015, 2015, live,apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf," title="web.archive.org/web/20150501002853apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf,">web.archive.org/web/20150501002853apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf, 1 May 2015, Some evidence finds a higher rate of 19% may result in better outcomes.JOURNAL, Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, Shah N, Semrau K, Berry WR, Gawande AA, Haynes AB, Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality, JAMA, 314, 21, 2263–2270, December 2015, 26624825, 10.1001/jama.2015.15553, free, 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.WEB, Births: Provisional Data for 2017,www.cdc.gov/nchs/data/vsrr/report004.pdf,web.archive.org/web/20180517190023/https://www.cdc.gov/nchs/data/vsrr/report004.pdf, 2018-05-17, live, CDC, 18 May 2018, May 2018, 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 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.JOURNAL, Meehan, F. P., January 1988, Caesarean section-past, present and what of the future?,dx.doi.org/10.3109/01443618809012284, Journal of Obstetrics and Gynaecology, 8, 3, 201–205, 10.3109/01443618809012284, 0144-3615, WEB, Cesarean Section - A Brief History preface,www.nlm.nih.gov/exhibition/cesarean/preface.html, 2024-03-14, www.nlm.nih.gov, 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.JOURNAL, Dhakal-Rai, Sulochana, van Teijlingen, Edwin, Regmi, P., Wood, Juliet, Dangal, G., Dhakal, K. B., 2021-10-10, A brief history and indications for cesarean section,eprints.bournemouth.ac.uk/36095/, Journal of Patan Academy of Health Sciences, en, 8, 3, e1–e10, 10.3126/jpahs.v8i3.27657, 2091-2749, JOURNAL, Hillan, E M, October 1991, Caesarean Section: Historical Background,journals.sagepub.com/doi/10.1177/003693309103600511, Scottish Medical Journal, en, 36, 5, 150–154, 10.1177/003693309103600511, 1788548, 0036-9330, 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, survival of both the mother and baby, and thus the procedure, became significantly more common.BOOK, Moore MC, de Costa C, A Brief History of Cesarean Section, Cesarean Section: Understanding and Celebrating Your Baby’s Birth, 2004, JHU Press, 978-0-8018-8133-6, 31,books.google.com/books?id=Slf7Rp1zG6YC&pg=PT31, en, WEB,www.todayifoundout.com/index.php/2013/10/caesarean-sections-named-emperor-julius-caesar, The Truth About Julius Caesar and “Caesarean” Sections, 25 October 2013, {{TOC limit|3}}

Uses

File:Cesarean section scar and linea nigra.JPG|thumb|right|A seven-week-old caesarean section scar and (linea nigra]] visible on a 31-year-old mother: Longitudinal incisions are still sometimes used.)Caesarean section (C-section) is recommended when vaginal delivery might pose a risk to the mother or baby. C-sections are also carried out for personal and social reasons on maternal request in some countries.

Medical uses

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

• Abnormal presentation (breech or (:wikt:transverse|transverse positions))
• Prolonged labor or a failure to progress (obstructed labour, also known as dystocia)
• Fetal distress
• Cord prolapse
• Uterine rupture or an elevated risk thereof
• Uncontrolled hypertension, pre-eclampsia,JOURNAL, Turner R, Caesarean Section Rates, Reasons for Operations Vary Between Countries, Family Planning Perspectives, 22, 6, 281–2, 1990, 10.2307/2135690, 2135690, or eclampsia in the mother
• Tachycardia in the mother or baby after amniotic rupture (the waters breaking)
• Placenta problems (placenta praevia, placental abruption or placenta accreta)
• Failed labor induction
• Failed instrumental delivery (by forceps 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)
• Umbilical cord abnormalities (vasa previa, multilobate including bilobate and succenturiate-lobed placentas, velamentous insertion)

Other complications of pregnancy, pre-existing conditions, and concomitant disease, 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 in the third trimesterWEB, Management of Genital Herpes in Pregnancy,www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/05/management-of-genital-herpes-in-pregnancy,archive.today/20210116112656/https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/05/management-of-genital-herpes-in-pregnancy, dead, 16 January 2021, ACOG, 3 May 2020, May 2020, (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 (from previous childbirth or Crohn’s disease)
• Bicornuate 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.JOURNAL, Savage W, The rising caesarean section rate: a loss of obstetric skill?, Journal of Obstetrics and Gynaecology, 27, 4, 339–346, May 2007, 17654182, 10.1080/01443610701337916, 27545840,

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 are: emphasizing a long latent phase of labor is not abnormal and not a justification for C-section; a new definition of the start of active labor from a cervical dilatation of 4 cm to a dilatation of 6 cm; and allowing women who have previously given birth to push for at least 2 hours, with 3 hours of pushing for women who have not previously given birth, before labor arrest is considered. Physical exercise during pregnancy decreases the risk.JOURNAL, Domenjoz I, Kayser B, Boulvain M, Effect of physical activity during pregnancy on mode of delivery, American Journal of Obstetrics and Gynecology, 211, 4, 401.e1–401.11, October 2014, 24631706, 10.1016/j.ajog.2014.03.030, 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 cesarean delivery with harms to the mother or child were not significantly different from when done in an inpatient setting.BOOK, McDonagh M, Skelly AC, Hermesch A, Tilden E, Brodt ED, Dana T, Ramirez S, Fu R, Kantner SN, Hsu F, Hart E,www.ncbi.nlm.nih.gov/books/NBK569292/, Cervical Ripening in the Outpatient Setting, 2021, Agency for Healthcare Research and Quality (US), AHRQ Comparative Effectiveness Reviews, Rockville (MD), 33818996,

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 gives the risk of death for the mother as three times that of a vaginal birth.WEB,www.nhsdirect.nhs.uk/articles/article.aspx?articleId=71§ionId=7681, Caesarean Section, NHS Direct, 26 July 2006, dead,www.nhsdirect.nhs.uk/articles/article.aspx?articleId=71§ionId=7681," title="web.archive.org/web/20090201155120www.nhsdirect.nhs.uk/articles/article.aspx?articleId=71§ionId=7681,">web.archive.org/web/20090201155120www.nhsdirect.nhs.uk/articles/article.aspx?articleId=71§ionId=7681, 1 February 2009, 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.JOURNAL, Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS, Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term, CMAJ, 176, 4, 455–460, February 2007, 17296957, 1800583, 10.1503/cmaj.060870, File:Normal post-Caesarean.jpg|thumb|Transvaginal ultrasonographyTransvaginal ultrasonographyA caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction), and wound infections.JOURNAL, Pain M, Medical Interventions: Caesarean Sections as a Case Study, Economic and Political Weekly, 35, 31, 2755–61, 2000, If a caesarean is performed in an emergency, the risk of the surgery may be increased due to a number of factors. The patient’s stomach may not be empty, increasing the risk of anaesthesia.WEB,www.gynaecworld.com/Pregnancy/pg9.html#3, Why are Caesareans Done?, Gynaecworld, 26 July 2006, dead,www.gynaecworld.com/Pregnancy/pg9.html#3," title="web.archive.org/web/20081203134401www.gynaecworld.com/Pregnancy/pg9.html#3,">web.archive.org/web/20081203134401www.gynaecworld.com/Pregnancy/pg9.html#3, 3 December 2008, 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%.JOURNAL, Saeed KB, Greene RA, Corcoran P, O’Neill SM, Incidence of surgical site infection following caesarean section: a systematic review and meta-analysis protocol, BMJ Open, 7, 1, e013037, January 2017, 28077411, 5253548, 10.1136/bmjopen-2016-013037, The presence of chorioamnionitis and obesity 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 which 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.JOURNAL, Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O’Sullivan MJ, Sibai B, Langer O, Thorp JM, Ramin SM, Mercer BM, Maternal morbidity associated with multiple repeat cesarean deliveries, Obstetrics and Gynecology, 107, 6, 1226–1232, June 2006, 16738145, 10.1097/01.AOG.0000219750.79480.84, 257455, 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.JOURNAL, Olde E, van der Hart O, Kleber R, van Son M, Posttraumatic stress following childbirth: a review, Clinical Psychology Review, 26, 1, 1–16, January 2006, 16176853, 10.1016/j.cpr.2005.07.002, free, 22137961, 1874/16760, 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

{{Further|Delivery after previous caesarean section}}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.JOURNAL, Gurol-Urganci I, Bou-Antoun S, Lim CP, Cromwell DA, Mahmood TA, Templeton A, van der Meulen JH, Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis, Human Reproduction, 28, 7, 1943–1952, July 2013, 23644593, 10.1093/humrep/det130, free, 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:WEB, UpToDate,www.uptodate.com/contents/choosing-the-route-of-delivery-after-cesarean-birth, 2024-02-10, www.uptodate.com,

• 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 of the child (0.25 per 1,000).WEB,www.rcog.org.uk/globalassets/documents/guidelines/gtg4511022011.pdf, Birth After Previous Caesarean Birth, Green-top Guideline No. 45, February 2007, Royal College of Obstetricians and Gynaecologists, dead,web.archive.org/web/20141207031819/https://www.rcog.org.uk/globalassets/documents/guidelines/gtg4511022011.pdf, 7 December 2014, 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.JOURNAL, ACOG Practice bulletin no. 115: Vaginal birth after previous cesarean delivery, Obstetrics and Gynecology, 116, 2 Pt 1, 450–463, August 2010, 20664418, 10.1097/AOG.0b013e3181eeb251,

Adhesions

(File:Suturing uterus.JPG|thumb|Suturing of the uterus after extraction) There are several steps that can be taken during abdominal or pelvic surgery to minimize postoperative complications, such as the formation of 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 complication of any abdominal or pelvic surgery. 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, 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).WEB,www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf, Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age, 13 July 2012, dead,www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf," title="web.archive.org/web/20121120003529www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf,">web.archive.org/web/20121120003529www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf, 20 November 2012, 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.JOURNAL, Reddy UM, Bettegowda VR, Dias T, Yamada-Kushnir T, Ko CW, Willinger M, Term pregnancy: a period of heterogeneous risk for infant mortality, Obstetrics and Gynecology, 117, 6, 1279–1287, June 2011, 21606738, 5485902, 10.1097/AOG.0b013e3182179e28, The American Congress of Obstetricians and Gynecologists and medical policy makers review research studies and find more incidence of suspected or proven sepsis, 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 pregnancies where both twins are head down a trial of vaginal delivery is recommended at between 37 and 38 weeks.REPORT, Caesarean Section: NICE Clinical Guidelines, No. 132, 2011, 23285498,www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050826/, live, National Institute of Health and Clinical Excellence, National Institute for Health and Clinical Excellence: Guidance,www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050826/," title="web.archive.org/web/20160102022125www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050826/,">web.archive.org/web/20160102022125www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050826/, 2 January 2016, Vaginal delivery, in this case, does not worsen the outcome for either infant as compared with caesarean section.JOURNAL, Biswas A, Su LL, Mattar C, Caesarean section for preterm birth and, breech presentation and twin pregnancies, Best Practice & Research. Clinical Obstetrics & Gynaecology, 27, 2, 209–219, April 2013, 23062593, 10.1016/j.bpobgyn.2012.09.002, 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.JOURNAL, Lee YM, Delivery of twins, Seminars in Perinatology, 36, 3, 195–200, June 2012, 22713501, 10.1053/j.semperi.2012.02.004, JOURNAL, Hack KE, Derks JB, Elias SG, Franx A, Roos EJ, Voerman SK, Bode CL, Koopman-Esseboom C, Visser GH, Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study, BJOG, 115, 1, 58–67, January 2008, 17999692, 10.1111/j.1471-0528.2007.01556.x, 20983040, 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).JOURNAL, Danon D, Sekar R, Hack KE, Fisk NM, Increased stillbirth in uncomplicated monochorionic twin pregnancies: a systematic review and meta-analysis, Obstetrics and Gynecology, 121, 6, 1318–1326, June 2013, 23812469, 10.1097/AOG.0b013e318292766b, 5152813, 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 is higher after this gestation than the risk of complications of prematurity.JOURNAL, Pasquini L, Wimalasundera RC, Fichera A, Barigye O, Chappell L, Fisk NM, High perinatal survival in monoamniotic twins managed by prophylactic sulindac, intensive ultrasound surveillance, and Cesarean delivery at 32 weeks’ gestation, Ultrasound in Obstetrics & Gynecology, 28, 5, 681–687, October 2006, 17001748, 10.1002/uog.3811, 26098748, free, JOURNAL, Murata M, Ishii K, Kamitomo M, Murakoshi T, Takahashi Y, Sekino M, Kiyoshi K, Sago H, Yamamoto R, Kawaguchi H, Mitsuda N, Perinatal outcome and clinical features of monochorionic monoamniotic twin gestation, The Journal of Obstetrics and Gynaecology Research, 39, 5, 922–925, May 2013, 23510453, 10.1111/jog.12014, 40347063, JOURNAL, Baxi LV, Walsh CA, Monoamniotic twins in contemporary practice: a single-center study of perinatal outcomes, The Journal of Maternal-Fetal & Neonatal Medicine, 23, 6, 506–510, June 2010, 19718582, 10.3109/14767050903214590, 37447326, In a research study widely publicized, singleton children born earlier than 39 weeks may have developmental problems, including slower learning in reading and math.WEB,pediatrics.aappublications.org/content/early/2012/06/27/peds.2011-2157d.abstract?sid=b95d99e5-556e-45d3-8326-e77459528363, Academic Achievement Varies With Gestational Age Among Children Born at Term, 12 July 2012, live,pediatrics.aappublications.org/content/early/2012/06/27/peds.2011-2157d.abstract?sid=b95d99e5-556e-45d3-8326-e77459528363," title="web.archive.org/web/20150904045302pediatrics.aappublications.org/content/early/2012/06/27/peds.2011-2157d.abstract?sid=b95d99e5-556e-45d3-8326-e77459528363,">web.archive.org/web/20150904045302pediatrics.aappublications.org/content/early/2012/06/27/peds.2011-2157d.abstract?sid=b95d99e5-556e-45d3-8326-e77459528363, 4 September 2015, 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.BOOK, Jha K, Nassar GN, Makker K, Transient Tachypnea of the Newborn, 2022,www.ncbi.nlm.nih.gov/books/NBK537354/, StatPearls, Treasure Island (FL), StatPearls Publishing, 30726039, 2022-06-22,
• 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.WEB,www.npr.org/templates/story/story.php?storyId=99132594, Study: Early Repeat C-Sections Puts Babies At Risk,www.npr.org/templates/story/story.php?storyId=99132594," title="web.archive.org/web/20160131115102www.npr.org/templates/story/story.php?storyId=99132594,">web.archive.org/web/20160131115102www.npr.org/templates/story/story.php?storyId=99132594, 31 January 2016, NPR.org, 8 January 2009, 26 July 2011,
• 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.WEB,www.medicineonline.com/news/12/6008/High-infant-mortality-seen-with-elective-c-section.html, High infant mortality rate seen with elective c-section, Reuters Health—September 2006, Medicineonline.com, 14 September 2006, 26 July 2011, dead,www.medicineonline.com/news/12/6008/High-infant-mortality-seen-with-elective-c-section.html," title="web.archive.org/web/20110718123744www.medicineonline.com/news/12/6008/High-infant-mortality-seen-with-elective-c-section.html,">web.archive.org/web/20110718123744www.medicineonline.com/news/12/6008/High-infant-mortality-seen-with-elective-c-section.html, 18 July 2011,

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.JOURNAL, Mueller NT, Zhang M, Hoyo C, Østbye T, Benjamin-Neelon SE, Does cesarean delivery impact infant weight gain and adiposity over the first year of life?, International Journal of Obesity, 43, 8, 1549–1555, August 2019, 30349009, 6476694, 10.1038/s41366-018-0239-2, C. Yuan et al. (2016), “Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood”, JAMA Pediatrics. However, caesarean deliveries are found to not affect a newborn’s risk of developing food allergy.JOURNAL, Currell A, Koplin JJ, Lowe AJ, Perrett KP, Ponsonby AL, Tang ML, Dharmage SC, Peters RL, Mode of Birth Is Not Associated With Food Allergy Risk in Infants, English, The Journal of Allergy and Clinical Immunology. In Practice, 10, 8, 2135–2143.e3, August 2022, 35597762, 10.1016/j.jaip.2022.03.031, 248903112, This finding contradicts a previous study that claims babies born via caesarean section have lower levels of Bacteroides that is linked to peanut allergy in infants.WEB, 2021-04-30, Why C-Section Babies May Be at Higher Risk for a Food Allergy,consumer.healthday.com/4-29-why-c-section-babies-may-be-at-higher-risk-for-a-food-allergy-2652675840.html, 2022-05-25, Consumer Health News {{!, HealthDay |language=en}}

Classification

Caesarean sections have been classified in various ways by different perspectives.JOURNAL, Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, Gulmezoglu M, Merialdi M, Classifications for cesarean section: a systematic review, PLOS ONE, 6, 1, e14566, January 2011, 21283801, 3024323, 10.1371/journal.pone.0014566, free, 2011PLoSO...614566T, 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 or an emergency operation.JOURNAL, Lucas DN, Yentis SM, Kinsella SM, Holdcroft A, May AE, Wee M, Robinson PN, Urgency of caesarean section: a new classification, Journal of the Royal Society of Medicine, 93, 7, 346–350, July 2000, 10928020, 1298057, 10.1177/014107680009300703, 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 general anesthesia 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.)WEB, Miheso J, Burns S, Care of women undergoing emergency caesarean section,www.wwl.nhs.uk/Library/FOI/Requests/2013-2014/July_2013/1678_Emergency_Caesarean_Section_Jul12.pdf, NHS Choices, 7 March 2018, 8 March 2018,web.archive.org/web/20180308103403/https://www.wwl.nhs.uk/Library/FOI/Requests/2013-2014/July_2013/1678_Emergency_Caesarean_Section_Jul12.pdf, dead, Elective caesarean sections may be performed on the basis of 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.JOURNAL, ACOG committee opinion no. 559: Cesarean delivery on maternal request, Obstetrics and Gynecology, 121, 4, 904–907, April 2013, 23635708, 10.1097/01.AOG.0000428647.67925.d3, The National Institute for Health and Care Excellence 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 and hepatitis C virus transmission.JOURNAL, Yang J, Zeng XM, Men YL, Zhao LS, Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review, Virology Journal, 5, 1, 100, August 2008, 18755018, 2535601, 10.1186/1743-422X-5-100, free, JOURNAL, Borgia G, Carleo MA, Gaeta GB, Gentile I, Hepatitis B in pregnancy, World Journal of Gastroenterology, 18, 34, 4677–4683, September 2012, 23002336, 3442205, 10.3748/wjg.v18.i34.4677, free, JOURNAL, Hu Y, Chen J, Wen J, Xu C, Zhang S, Xu B, Zhou YH, Effect of elective cesarean section on the risk of mother-to-child transmission of hepatitis B virus, BMC Pregnancy and Childbirth, 13, 1, 119, May 2013, 23706093, 3664615, 10.1186/1471-2393-13-119, free, JOURNAL, McIntyre PG, Tosh K, McGuire W, Caesarean section versus vaginal delivery for preventing mother to infant hepatitis C virus transmission, The Cochrane Database of Systematic Reviews, 2006, 4, CD005546, October 2006, 17054264, 8895451, 10.1002/14651858.CD005546.pub2, JOURNAL, A significant sex--but not elective cesarean section--effect on mother-to-child transmission of hepatitis C virus infection, The Journal of Infectious Diseases, 192, 11, 1872–1879, December 2005, 16267757, 10.1086/497695, free, European Paediatric Hepatitis C Virus Network,

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 via a caesarean section is requested by the pregnant patient even though there is not a medical indication to have the surgery.JOURNAL, NIH, National Institutes of Health state-of-the-science conference statement: Cesarean delivery on maternal request March 27-29, 2006, Obstetrics and Gynecology, 107, 6, 1386–1397, June 2006, 16738168, 10.1097/00006250-200606000-00027,consensus.nih.gov/2006/CesareanStatement_Final053106.pdf, dead, 30 December 2008,web.archive.org/web/20170118080344/https://consensus.nih.gov/2006/CesareanStatement_Final053106.pdf, 18 January 2017, Systematic reviews have found no strong evidence about the impact of caesareans for nonmedical reasons.JOURNAL, Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GM, Caesarean section for non-medical reasons at term, The Cochrane Database of Systematic Reviews, 2012, 3, CD004660, March 2012, 22419296, 4171389, 10.1002/14651858.CD004660.pub3, Recommendations encourage counseling to identify the reasons for the request, addressing anxieties and information, and encouraging vaginal birth.WEB,www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Elective-Surgery-and-Patient-Choice, Elective Surgery and Patient Choice – ACOG,web.archive.org/web/20150925012637/https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Elective-Surgery-and-Patient-Choice, 25 September 2015, live, 4 October 2015, Elective caesareans at 38 weeks in some studies showed increased health complications in the newborn. For this reason ACOG and NICE recommend that elective caesarean sections should not be scheduled before 39 weeks gestation unless there is a medical reason.JOURNAL, Glavind J, Uldbjerg N, Elective cesarean delivery at 38 and 39 weeks: neonatal and maternal risks, Current Opinion in Obstetrics & Gynecology, 27, 2, 121–127, April 2015, 25689238, 10.1097/gco.0000000000000158, 32050828, WEB,www.nice.org.uk/guidance/CG132, Caesarean section {{!, Guidance and guidelines {{!}} NICE|website=www.nice.org.uk|date=23 November 2011 |access-date=5 January 2019}} Planned caesarean sections may be scheduled earlier if there is a medical reason.

After previous caesarean

{{See also|Delivery after previous caesarean section}}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 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).WEB, ((WebMD Editorial Contributors)), Johnson TC,www.webmd.com/baby/tc/vaginal-birth-after-cesarean-vbac-overview, Vaginal Birth After Cesarean (VBAC) – Overview,www.webmd.com/baby/tc/vaginal-birth-after-cesarean-vbac-overview," title="web.archive.org/web/20091230133854www.webmd.com/baby/tc/vaginal-birth-after-cesarean-vbac-overview,">web.archive.org/web/20091230133854www.webmd.com/baby/tc/vaginal-birth-after-cesarean-vbac-overview, 30 December 2009, WebMD, 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.WEB,www.americanpregnancy.org/labornbirth/vbac.html, Vaginal Birth after Cesarean (VBAC), American Pregnancy Association, 16 June 2012, dead,www.americanpregnancy.org/labornbirth/vbac.html," title="web.archive.org/web/20120621050450www.americanpregnancy.org/labornbirth/vbac.html,">web.archive.org/web/20120621050450www.americanpregnancy.org/labornbirth/vbac.html, 21 June 2012, 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.WEB,www.mayoclinic.com/health/vbac/VB99999, Vaginal birth after C-section (VBAC) guide,www.mayoclinic.com/health/vbac/vb99999," title="web.archive.org/web/20100312103525www.mayoclinic.com/health/vbac/vb99999,">web.archive.org/web/20100312103525www.mayoclinic.com/health/vbac/vb99999, 12 March 2010, Mayo Clinic, WEB,www.cdc.gov/nchs/data/databriefs/db35.htm#ref1, NCHS Data Brief: Recent Trends in Cesarean Delivery in the United States Products, Centers for Disease Control and Prevention, March 2010, 16 June 2012, live,www.cdc.gov/nchs/data/databriefs/db35.htm#ref1," title="web.archive.org/web/20120517145002www.cdc.gov/nchs/data/databriefs/db35.htm#ref1,">web.archive.org/web/20120517145002www.cdc.gov/nchs/data/databriefs/db35.htm#ref1, 17 May 2012,

Twins

For otherwise healthy twin pregnancies where both twins are head down a trial of vaginal delivery 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 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 not known 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.JOURNAL, Lee HC, Gould JB, Boscardin WJ, El-Sayed YY, Blumenfeld YJ, Trends in cesarean delivery for twin births in the United States: 1995-2008, Obstetrics and Gynecology, 118, 5, 1095–1101, November 2011, 22015878, 3202294, 10.1097/AOG.0b013e3182318651,

Breech birth

A breech birth is the birth of a baby from a breech presentation, in which the baby exits the pelvis with the buttocks or feet 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.JOURNAL, Hofmeyr GJ, Hannah M, Lawrie TA, Planned caesarean section for term breech delivery, The Cochrane Database of Systematic Reviews, 2015, 7, CD000166, July 2015, 26196961, 6505736, 10.1002/14651858.CD000166.pub2, 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 and midwifery.Though vaginal birth 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 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 has occurred, to assist in resuscitation 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 prior to the limit of fetal viability 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 uterus, 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 bladder. It results in less blood loss 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 consists of a caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta 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 which has been used nearly all over the world 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 1994Stark M. Technique of cesarean section: Misgav Ladach method. In: Popkin DR, Peddle LJ (eds): Women’s Health Today. Perspectives on current research and clinical practice. Proceedings of the XIV World Congress of Gynaecology and Obstetrics, Montreal. Parthenon Publishing group, New York, 81–5 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 way of 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. There are many publications 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.JOURNAL, Nabhan AF, Long-term outcomes of two different surgical techniques for cesarean, International Journal of Gynaecology and Obstetrics, 100, 1, 69–75, January 2008, 17904561, 10.1016/j.ijgo.2007.07.011, 5847957, JOURNAL, Hudić I, Bujold E, FatuÅ¡ić Z, Skokić F, Latifagić A, Kapidžić M, FatuÅ¡ić J, The Misgav-Ladach method of cesarean section: a step forward in operative technique in obstetrics, Archives of Gynecology and Obstetrics, 286, 5, 1141–1146, November 2012, 22752598, 10.1007/s00404-012-2448-6, 809690, Since 2015, the World Health Organization has endorsed the Robson classification as a holistic means of comparing childbirth rates between different settings, with a view to allowing more accurate comparison of caesarean section rates.JOURNAL, ((World Health Organization Human Reproduction Programme)), WHO Statement on caesarean section rates, Reproductive Health Matters, 23, 45, 149–150, May 2015, 26278843, 10.1016/j.rhm.2015.07.007, free, 40829330, 11343/249912,

Technique

(File:Cesareo.svg|thumb|Several caesarean sectionsIs: supra-umbilical incisionIm: median incisionIM: Maylard incisionIP: Pfannenstiel incision)(File:Caesarian section - Pull out.jpg|thumb|Removal of the baby)(File:Blausen 0223 CesareanDelivery.png|thumb|Illustration depicting caesarean section)Antibiotic prophylaxis is used before an incision.JOURNAL, Dahlke JD, Mendez-Figueroa H, Rouse DJ, Berghella V, Baxter JK, Chauhan SP, Evidence-based surgery for cesarean delivery: an updated systematic review, American Journal of Obstetrics and Gynecology, 209, 4, 294–306, October 2013, 23467047, 10.1016/j.ajog.2013.02.043, The uterus is incised, and this incision is extended with blunt pressure along a cephalad-caudad axis. The infant is delivered, and the placenta is then removed. The surgeon then makes a decision 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 is used. Discouraged practices include manual cervical dilation, any subcutaneous drain,JOURNAL, Gates S, Anderson ER, Wound drainage for caesarean section, The Cochrane Database of Systematic Reviews, 12, CD004549, December 2013, 24338262, 10.1002/14651858.CD004549.pub3, or supplemental oxygen therapy with intent to prevent infection.Caesarean section can be performed with single or double layer suturing of the uterine incision.JOURNAL, Stark M, Chavkin Y, Kupfersztain C, Guedj P, Finkel AR, Evaluation of combinations of procedures in cesarean section, International Journal of Gynaecology and Obstetrics, 48, 3, 273–276, March 1995, 7781869, 10.1016/0020-7292(94)02306-J, 72559269, 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.JOURNAL, Dodd JM, Anderson ER, Gates S, Grivell RM, Surgical techniques for uterine incision and uterine closure at the time of caesarean section, The Cochrane Database of Systematic Reviews, 7, CD004732, July 2014, 25048608, 10.1002/14651858.CD004732.pub3, Standard procedure includes the closure of the peritoneum. Research questions whether this is needed, with some studies indicating peritoneal closure is associated with longer operative time and hospital stay.JOURNAL, Bamigboye AA, Hofmeyr GJ, Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes, The Cochrane Database of Systematic Reviews, 2014, 8, CD000163, August 2014, 25110856, 4448220, 10.1002/14651858.CD000163.pub2, The Misgav Ladach method is a surgery technical that may have fewer secondary complications and faster healing, due to the insertion into the muscle.JOURNAL, Holmgren G, Sjöholm L, Stark M, The Misgav Ladach method for cesarean section: method description, Acta Obstetricia et Gynecologica Scandinavica, 78, 7, 615–621, August 1999, 10422908, 10.1034/j.1600-0412.1999.780709.x, 25845500,

Anesthesia

Both general and regional anaesthesia (spinal, epidural 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 with respect to major outcomes in the mother or baby.JOURNAL, Afolabi BB, Lesi FE, Regional versus general anaesthesia for caesarean section, The Cochrane Database of Systematic Reviews, 10, CD004350, October 2012, 23076903, 10.1002/14651858.CD004350.pub3, Regional anaesthesia may be preferred as it allows the mother to be awake and interact immediately with her baby.JOURNAL, Hawkins JL, Koonin LM, Palmer SK, Gibbs CP, Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990, Anesthesiology, 86, 2, 277–284, February 1997, 9054245, 10.1097/00000542-199702000-00002, 21467445, free, Compared to general anaesthesia, regional anaesthesia is better at preventing persistent postoperative pain 3 to 8 months after caesarean section.JOURNAL, Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, Hall CB, Andreae MH, Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children, The Cochrane Database of Systematic Reviews, 6, 6, CD007105, June 2018, 29926477, 6377212, 10.1002/14651858.CD007105.pub4, Other advantages of regional anesthesia may include the absence of typical risks of general anesthesia: pulmonary aspiration (which has a relatively high incidence in patients undergoing anesthesia in late pregnancy) of gastric contents and esophageal intubation. 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.JOURNAL, Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA, Obstetric anesthesia workforce survey: twenty-year update, Anesthesiology, 103, 3, 645–653, September 2005, 16129992, 10.1097/00000542-200509000-00030, free, Regional anaesthesia during caesarean section is different from the analgesia (pain relief) used in labor and vaginal delivery.JOURNAL, Wang SC, Pan PT, Chiu HY, Huang CJ, Neuraxial magnesium sulfate improves postoperative analgesia in Cesarean section delivery women: A meta-analysis of randomized controlled trials, Asian Journal of Anesthesiology, 55, 3, 56–67, September 2017, 28797894, 10.1016/j.aja.2017.06.005, free, JOURNAL, Lavoie A, Toledo P, Multimodal postcesarean delivery analgesia, Clinics in Perinatology, 40, 3, 443–455, September 2013, 23972750, 10.1016/j.clp.2013.05.008, Pain Management in the Peripartum Period, JOURNAL, Nardi N, Campillo-Gimenez B, Pong S, Branchu P, Ecoffey C, Wodey E, [Chronic pain after cesarean: Impact and risk factors associated], fr, Annales Françaises d’Anesthésie et de Réanimation, 32, 11, 772–778, November 2013, 24138769, 10.1016/j.annfar.2013.08.007, The pain that is experienced because of surgery is greater than that of labor and therefore requires a more intense nerve block.General anesthesia may be necessary because of specific risks to 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.JOURNAL, Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, etal, Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013, Lancet, 384, 9947, 980–1004, September 2014, 24797575, 4255481, 10.1016/S0140-6736(14)60696-6, JOURNAL, Smaill FM, Grivell RM, Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section, The Cochrane Database of Systematic Reviews, 2014, 10, CD007482, October 2014, 25350672, 4007637, 10.1002/14651858.CD007482.pub3, 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 to substantially reduce the incidence of febrile morbidity. Infection can occur in around 8% of women who have caesareans, largely endometritis, urinary tract infections and wound infections. The use of preventative antibiotics in women undergoing caesarean section decreased wound infection, endometritis, and serious infectious complications by about 65%. Side effects and effect on the baby is 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.JOURNAL, Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK, Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery, The Cochrane Database of Systematic Reviews, 12, CD009516, December 2014, 25479008, 10.1002/14651858.CD009516.pub2, Moderate certainty evidence suggest that chlorhexidine gluconate as a skin preparation is slightly more effective in prevention surgical site infections than povidone-iodine but further research is needed.JOURNAL, Hadiati DR, Hakimi M, Nurdiati DS, Masuzawa Y, da Silva Lopes K, Ota E, Skin preparation for preventing infection following caesarean section, The Cochrane Database of Systematic Reviews, 2020, 6, CD007462, June 2020, 32580252, 7386833, 10.1002/14651858.CD007462.pub5, Some doctors believe that during a caesarean section, mechanical cervical dilation 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 {{As of|2018|lc=y}} neither supported nor refuted this practice for reducing postoperative morbidity, pending further large studies.JOURNAL, Liabsuetrakul T, Peeyananjarassri K, Mechanical dilatation of the cervix during elective caeserean section before the onset of labour for reducing postoperative morbidity, The Cochrane Database of Systematic Reviews, 8, 8, CD008019, August 2018, 30096215, 6513223, 10.1002/14651858.CD008019.pub3, Hypotension (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.JOURNAL, Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, Simmons SW, Cyna AM, Techniques for preventing hypotension during spinal anaesthesia for caesarean section, The Cochrane Database of Systematic Reviews, 2020, 7, CD002251, July 2020, 32619039, 7387232, 10.1002/14651858.CD002251.pub4,

Skin-to-skin contact

The WHO and UNICEF 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 anesthetic the father or other family member may provide SSC until the mother is able.JOURNAL, Stevens J, Schmied V, Burns E, Dahlen H, Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature, Maternal & Child Nutrition, 10, 4, 456–473, October 2014, 24720501, 6860199, 10.1111/mcn.12128, It is known that during the hours of labor before a vaginal birth a woman’s body begins to produce oxytocin 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.JOURNAL, Pereira Gomes Morais E, Riera R, Porfírio GJ, Macedo CR, Sarmento Vasconcelos V, de Souza Pedrosa A, Torloni MR, Chewing gum for enhancing early recovery of bowel function after caesarean section, The Cochrane Database of Systematic Reviews, 2016, 10, CD011562, October 2016, 27747876, 6472604, 10.1002/14651858.CD011562.pub2, Poorly controlled pain following non-emergent caesarean section occurs in between 13% and 78% of women.JOURNAL, Yang MM, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, Riva-Cambrin J, Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis, BMJ Open, 9, 4, e025091, April 2019, 30940757, 6500309, 10.1136/bmjopen-2018-025091, Following caesarean delivery, complementary and alternative therapies (e.g., acupuncture) may help to relieve pain, though evidence supporting the efficacy of such treatments is extremely limited.JOURNAL, Zimpel SA, Torloni MR, Porfírio GJ, Flumignan RL, da Silva EM, Complementary and alternative therapies for post-caesarean pain, The Cochrane Database of Systematic Reviews, 2020, 9, CD011216, September 2020, 32871021, 9701535, 10.1002/14651858.CD011216.pub2, 221466152, 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.WEB,www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/c-section-recovery/art-20047310, C-section recovery: What to expect, Mayo Clinic, 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.JOURNAL, Lydon-Rochelle MT, Holt VL, Martin DP, Delivery method and self-reported postpartum general health status among primiparous women, Paediatric and Perinatal Epidemiology, 15, 3, 232–240, July 2001, 11489150, 10.1046/j.1365-3016.2001.00345.x, 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.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.JOURNAL, Jin J, Peng L, Chen Q, Zhang D, Ren L, Qin P, Min S, Prevalence and risk factors for chronic pain following cesarean section: a prospective study, BMC Anesthesiology, 16, 1, 99, October 2016, 27756207, 5069795, 10.1186/s12871-016-0270-6, free, In recent meta-analyses, caesarean section has been associated to a lower risk of urinary incontinence and pelvic organ prolapse compared to vaginal delivery.JOURNAL, Keag OE, Norman JE, Stock SJ, Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis, PLOS Medicine, 15, 1, e1002494, January 2018, 29360829, 5779640, 10.1371/journal.pmed.1002494, free, JOURNAL, Gachon B, De Tayrac R, Schmitz T, Mahmood T, Nizard J, Fritel X, Should we advise women that pre-labor caesarean section prevents pelvic floor dysfunction?, European Journal of Obstetrics, Gynecology, and Reproductive Biology, 244, 31–34, January 2020, 31731021, 10.1016/j.ejogrb.2019.10.037, 208064082, free, 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.JOURNAL, Fitzpatrick, Kathryn E., Abdel-Fattah, Mohamed, Hemelaar, Joris, Kurinczuk, Jennifer J., Quigley, Maria A., 2022-11-22, Planned mode of birth after previous cesarean section and risk of undergoing pelvic floor surgery: A Scottish population-based record linkage cohort study, PLOS Medicine, en, 19, 11, e1004119, 10.1371/journal.pmed.1004119, free, 1549-1676, 9681109, 36413515, JOURNAL, 23 January 2024, Does vaginal birth after a previous caesarean section increase the risk of pelvic floor surgery?,evidence.nihr.ac.uk/alert/does-vaginal-birth-after-previous-caesarean-section-increase-risk-pelvic-floor-surgery/, NIHR Evidence, 10.3310/nihrevidence_61860, 267222803,

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 towards increasing rates is particularly strong in middle and high income countries.BOOK, Santos, Gonçalo, Chinese Village Life Today: Building Families in an Age of Transition, 2021, University of Washington Press, 978-0-295-74738-5, Seattle, {{Rp|page=101}} In southern Africa, the cesarean rate is less than 5%; while the rate is almost 60% in some parts of Latin America.NEWS, Stemming the global caesarean section epidemic,www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32394-8/fulltext, 14 November 2018, The Lancet, 13 October 2018, The Canadian rate was 26% in 2005–2006.WEB,www.canada.com/windsorstar/story.html?id=cd328013-086c-4ad7-a03d-6211b1cf1f2d, C-section rate in Canada continues upward trend, Canada.com, 26 July 2007, dead,www.canada.com/windsorstar/story.html?id=cd328013-086c-4ad7-a03d-6211b1cf1f2d," title="web.archive.org/web/20140514183030www.canada.com/windsorstar/story.html?id=cd328013-086c-4ad7-a03d-6211b1cf1f2d,">web.archive.org/web/20140514183030www.canada.com/windsorstar/story.html?id=cd328013-086c-4ad7-a03d-6211b1cf1f2d, 14 May 2014, Australia has a high caesarean section rate, at 31% in 2007.NEWS,www.smh.com.au/opinion/society-and-culture/to-push-or-not-to-push-its-a-womans-right-to-decide-20110101-19ch2.html, The Sydney Morning Herald, To push or not to push? It’s a woman’s right to decide, 2 January 2011, live,www.smh.com.au/opinion/society-and-culture/to-push-or-not-to-push-its-a-womans-right-to-decide-20110101-19ch2.html," title="web.archive.org/web/20110830150304www.smh.com.au/opinion/society-and-culture/to-push-or-not-to-push-its-a-womans-right-to-decide-20110101-19ch2.html,">web.archive.org/web/20110830150304www.smh.com.au/opinion/society-and-culture/to-push-or-not-to-push-its-a-womans-right-to-decide-20110101-19ch2.html, 30 August 2011, dmy-all, 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.“NEWS,www.bbc.co.uk/news/10448034, BBC News, Should there be a limit on Caesareans?, 30 June 2010, live,www.bbc.co.uk/news/10448034," title="web.archive.org/web/20100720032957www.bbc.co.uk/news/10448034,">web.archive.org/web/20100720032957www.bbc.co.uk/news/10448034, 20 July 2010, dmy-all, More than 50 nations have rates greater than 27%. Another 45 countries have rates less than 7.5%. There are efforts to both improve access to and reduce the use of C-section. Globally, 1% of all caesarean deliveries are carried out without medical need. Overall, the caesarean section rate was 25.7% for 2004–2008.WEB,www.who.int/reproductivehealth/topics/maternal_perinatal/globalsurvey/en/, WHO | Global survey on maternal and perinatal health, 15 July 2017, live,www.who.int/reproductivehealth/topics/maternal_perinatal/globalsurvey/en/," title="web.archive.org/web/20161110114949www.who.int/reproductivehealth/topics/maternal_perinatal/globalsurvey/en/,">web.archive.org/web/20161110114949www.who.int/reproductivehealth/topics/maternal_perinatal/globalsurvey/en/, 10 November 2016, JOURNAL, Souza JP, Gülmezoglu A, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, Ruyan P, Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health, BMC Medicine, 8, 1, 71, November 2010, 21067593, 2993644, 10.1186/1741-7015-8-71, free, There is no significant difference in caesarean rates when comparing midwife continuity care to conventional fragmented care.JOURNAL, Hodnett ED, Continuity of caregivers for care during pregnancy and childbirth, The Cochrane Database of Systematic Reviews, 2, CD000062, 2000, 10796108, 10.1002/14651858.CD000062, Hodnett E, JOURNAL, Hodnett ED, WITHDRAWN: Continuity of caregivers for care during pregnancy and childbirth, The Cochrane Database of Systematic Reviews, 4, CD000062, October 2008, 2008, 18843605, 10.1002/14651858.CD000062.pub2, 10866098, Henderson S, More emergency caesareans—about 66%—are performed during the day rather than the night.JOURNAL, Goldstick O, Weissman A, Drugan A, The circadian rhythm of “urgent” operative deliveries, The Israel Medical Association Journal, 5, 8, 564–566, August 2003, 12929294, The rate has risen to 46% in China and to levels of 25% and above in many Asian, European and Latin American countries.WEB,www.nbcnews.com/id/34826186, C-section rates around globe at ‘epidemic’ levels, 12 January 2010, Associated Press, AP / NBC News, 21 February 2010, 16 March 2013,www.nbcnews.com/id/34826186," title="web.archive.org/web/20130316020439www.nbcnews.com/id/34826186,">web.archive.org/web/20130316020439www.nbcnews.com/id/34826186, dead, In Brazil and Iran the caesarean section rate is greater than 40%.NEWS, More evidence for a link between Caesarean sections and obesity,www.economist.com/news/science-and-technology/21730131-bugs-picked-up-birth-are-good-you-more-evidence-link-between, The Economist, 11 October 2017, 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.JOURNAL, Ramires de Jesus G, Ramires de Jesus N, Peixoto-Filho FM, Lobato G, Caesarean rates in Brazil: what is involved?, BJOG, 122, 5, 606–609, April 2015, 25327984, 10.1111/1471-0528.13119, 43551235,

Europe

Across Europe, there are differences between countries: in Italy the caesarean section rate is 40%, while in the Nordic countries it is 14%.NEWS,www.bbc.co.uk/news/health-15840743, BBC News, Women can choose Caesarean birth, 23 November 2011, live,www.bbc.co.uk/news/health-15840743," title="web.archive.org/web/20120819201245www.bbc.co.uk/news/health-15840743,">web.archive.org/web/20120819201245www.bbc.co.uk/news/health-15840743, 19 August 2012, dmy-all, In the United Kingdom, in 2008, the rate was 24%.WEB,www.institute.nhs.uk/quality_and_value/high_volume_care/focus_on:_caesarean_section.html, Focus on: caesarean section—NHS Institute for Innovation and Improvement, Institute.nhs.uk, 8 October 2009, dead,www.institute.nhs.uk/quality_and_value/high_volume_care/focus_on%3A_caesarean_section.html," title="web.archive.org/web/20111228034801www.institute.nhs.uk/quality_and_value/high_volume_care/focus_on%3A_caesarean_section.html,">web.archive.org/web/20111228034801www.institute.nhs.uk/quality_and_value/high_volume_care/focus_on%3A_caesarean_section.html, 28 December 2011, 26 May 2012, In Ireland the rate was 26.1% in 2009.WEB,www.rcpi.ie/News/Pages/CaesareanSectionRates-MatrixMarch2011.aspx, Caesarean Section Rates Royal College of Physicians of Ireland, Rcpi.ie, dead,www.rcpi.ie/News/Pages/CaesareanSectionRates-MatrixMarch2011.aspx," title="web.archive.org/web/20120502072407www.rcpi.ie/News/Pages/CaesareanSectionRates-MatrixMarch2011.aspx,">web.archive.org/web/20120502072407www.rcpi.ie/News/Pages/CaesareanSectionRates-MatrixMarch2011.aspx, 2 May 2012, In Italy, the incidence of caesarean sections is particularly high, although it varies from region to region.NEWS, La clinica dei record: 9 neonati su 10 nati con il parto cesareo,www.corriere.it/cronache/09_gennaio_14/clinica_cesareo_margherita_de_bac_83de8688-e204-11dd-b227-00144f02aabc.shtml, Corriere della Sera, 14 January 2009, 5 February 2009, dead,www.corriere.it/cronache/09_gennaio_14/clinica_cesareo_margherita_de_bac_83de8688-e204-11dd-b227-00144f02aabc.shtml," title="web.archive.org/web/20090724030448www.corriere.it/cronache/09_gennaio_14/clinica_cesareo_margherita_de_bac_83de8688-e204-11dd-b227-00144f02aabc.shtml,">web.archive.org/web/20090724030448www.corriere.it/cronache/09_gennaio_14/clinica_cesareo_margherita_de_bac_83de8688-e204-11dd-b227-00144f02aabc.shtml, 24 July 2009, In Campania, 60% of 2008 births reportedly occurred via caesarean sections.NEWS, Sagliocco denuncia boom di parti cesarei in Campania,www.pupia.tv/campania/politica/3798/sagliocco-denuncia-boom-parti-cesarei-campania.html,www.pupia.tv/campania/politica/3798/sagliocco-denuncia-boom-parti-cesarei-campania.html," title="archive.today/20130418215746www.pupia.tv/campania/politica/3798/sagliocco-denuncia-boom-parti-cesarei-campania.html,">archive.today/20130418215746www.pupia.tv/campania/politica/3798/sagliocco-denuncia-boom-parti-cesarei-campania.html, dead, 18 April 2013, Pupia.tv, 31 January 2009, 5 February 2009, In the Rome region, the mean incidence is around 44%, but can reach as high as 85% in some private clinics.WEB,www.asplazio.it/asp_online/tut_soggetti_deb/files/files_cesareo/09/TC_tot08_09.pdf, Tassi di taglio cesareo per istituto ordinati (rango) per valore del tasso 2008. Anno 2008 - III trimestre 2009 (dati provvisori), Cesarean section rates by institution sorted (rank) by rate value 2008. Year 2008 - 3rd quarter 2009 (provisional data), it, 12 August 2009, dead,www.asplazio.it/asp_online/tut_soggetti_deb/files/files_cesareo/09/TC_tot08_09.pdf," title="web.archive.org/web/20110722024230www.asplazio.it/asp_online/tut_soggetti_deb/files/files_cesareo/09/TC_tot08_09.pdf,">web.archive.org/web/20110722024230www.asplazio.it/asp_online/tut_soggetti_deb/files/files_cesareo/09/TC_tot08_09.pdf, 22 July 2011, NEWS, Cesarei, alla Mater Dei il record,www.tgcom.mediaset.it/cronaca/articoli/articolo438555.shtml, Tgcom.mediaset.it, 14 January 2009, 5 February 2009,

United States

In the United States, cesarean deliveries began rising in the 1960s and started becoming routine in the 1960s and 1970s.{{Rp|page=101}}In the United States the rate of C-section 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.Pfuntner A., Wier L.M., Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. WEB,www.hcup-us.ahrq.gov/reports/statbriefs/sb165.jsp, Most Frequent Procedures Performed in U.S. Hospitals, 2011 – Statistical Brief #165, 22 October 2013, live,www.hcup-us.ahrq.gov/reports/statbriefs/sb165.jsp," title="web.archive.org/web/20131024180807www.hcup-us.ahrq.gov/reports/statbriefs/sb165.jsp,">web.archive.org/web/20131024180807www.hcup-us.ahrq.gov/reports/statbriefs/sb165.jsp, 24 October 2013, . Caesarean rates in the U.S. have risen considerably since 1996.WEB,www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf, Births: Preliminary Data for 2007, National Center for Health Statistics, 23 November 2006, live,www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf," title="web.archive.org/web/20130821102537www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf,">web.archive.org/web/20130821102537www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf, 21 August 2013, 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).WEB,www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf, National Vital Statistics Reports, 9 September 2017, live,web.archive.org/web/20170720102442/https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf, 20 July 2017, 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.JOURNAL, Moore JE, Witt WP, Elixhauser A, Complicating Conditions Associate With Childbirth, by Delivery Method and Payer, 2011., HCUP Statistical Brief, 173, Agency for Healthcare Research and Quality, Rockville, MD, April 2014,www.hcup-us.ahrq.gov/reports/statbriefs/sb173-Childbirth-Delivery-Complications.jsp, dead,web.archive.org/web/20140714142859/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb173-Childbirth-Delivery-Complications.jsp, 14 July 2014, dmy-all, 6 June 2014, 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.WEB, Hensley S, C-Sections And The Profit Motive In California,www.npr.org/sections/health-shots/2010/09/13/129826908/c-sections-and-the-profit-motive, NPR, 13 September 2010, November 25, 2022, 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 to 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 actually needed c-sections were not getting them.WEB, Vedantam S, Money May Be Motivating Doctors To Do More C-Sections,health.wusf.usf.edu/npr-health/2013-08-30/money-may-be-motivating-doctors-to-do-more-c-sections, NPR, 30 August 2013, November 25, 2022, Concerned over the rising number of cesarean deliveries and hospital costs, in 2009 Minnesota 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 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.JOURNAL, Kozhimannil KB, Graves AJ, Ecklund AM, Shah N, Aggarwal R, Snowden JM, Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy, Medical Care, 56, 8, 658–664, August 2018, 29912840, 10.1097/MLR.0000000000000937, 49305610, The rise of cesarean births in the United States has coincided with counter-movements emphasizing natural childbirth with a lesser degree of medical intervention.{{Rp|pages=101–102}}

China

The rate of cesarean sections began to sharply increase in China in the 1990s.{{Rp|page=101}} This increase was driven by the expansion of China’s modern hospital infrastructure, and occurred first in urban areas.{{Rp|page=101}} The rise in cesarean deliveries has also resulted in social critique of the medical establishment over the medical necessity of performing cesarean sections.{{Rp|pages=101–102}}

History

(File:A baby being removed from its dying mother’s womb via Caesar Wellcome V0014915.jpg|thumb|A baby being removed from its dying mother’s womb)File:Uganda cesarean section.gif|thumb|A caesarean section performed by indigenous healers in Kahura, Uganda. As observed by medical missionary Robert William FelkinRobert William FelkinHistorically, caesarean sections performed upon a live woman usually resulted in the death of the mother.BOOK, A History of Women’s Bodies, Shorter E, Basic Books, Inc. Publishers, 1982, 0-465-03029-7, 98,archive.org/details/historyofwomensb00shor/page/98, 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, Luzhong, a sixth-generation descendant of the mythical Yellow Emperor, had six sons, all born by “cutting open the body”. The sixth son Jilian founded the House of Mi that ruled the State of Chu ({{circa|1030}}–223 BC).WEB,www.guoxue.com/shibu/24shi/shiji/sj_040.htm, 楚世家 (House of Chu), Records of the Grand Historian, Qian S, zh, 3 December 2011, dead,www.guoxue.com/shibu/24shi/shiji/sj_040.htm," title="web.archive.org/web/20120310023405www.guoxue.com/shibu/24shi/shiji/sj_040.htm,">web.archive.org/web/20120310023405www.guoxue.com/shibu/24shi/shiji/sj_040.htm, 10 March 2012, Sima Qian, The Sanskrit medical treatise Sushruta Samhita, composed in the early 1st millennium CE, mentions post-mortem caesarean sections.JOURNAL, Lurie, Samuel, 2005-03-15, The changing motives of cesarean section: from the ancient world to the twenty-first century,dx.doi.org/10.1007/s00404-005-0724-4, Archives of Gynecology and Obstetrics, 271, 4, 281–285, 10.1007/s00404-005-0724-4, 15856269, 26690619, 0932-0067, The first available non-mythical record of a C-section is the mother of Bindusara (born {{circa|320 BC}}, ruled 298 â€“ {{circa|272 BC}}), the second Mauryan Samrat (emperor) of India, accidentally consumed poison and died when she was close to delivering him. Chanakya, 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.JOURNAL, Lurie S, The changing motives of cesarean section: from the ancient world to the twenty-first century, Archives of Gynecology and Obstetrics, 271, 4, 281–285, April 2005, 15856269, 10.1007/s00404-005-0724-4, 26690619, An early account of caesarean section in Iran (Persia) is mentioned in the book of Shahnameh, written around 1000 AD, and relates to the birth of Rostam, the legendary hero of that country.ENCYCLOPEDIA, Shahbazi AS, RUDABA, Encyclopedia Iranica, 19 July 2009,www.iranica.com/newsite/index.isc?Article=http://www.iranica.com/newsite/articles/sup/Rudaba.html, {{dead link|date=September 2017 |bot=Level C |fix-attempted=yes }}JOURNAL, Torpin R, Vafaie I, The birth of Rustam. An early account of cesarean section in Iran, American Journal of Obstetrics and Gynecology, 81, 185–189, January 1961, 13777540, 10.1016/S0002-9378(16)36323-2, According to the Shahnameh, the Simurgh 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 ().Pseudopedia RostamIn the Irish mythological text the Ulster Cycle, the character Furbaide Ferbend is said to have been born by posthumous caesarean section, after his mother was murdered by his evil aunt Medb.The Babylonian Talmud, an ancient Jewish 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. There is also some basis for supposing that Jewish women regularly survived the operation in Roman times (as early as the 2nd century AD).JOURNAL, Boss J, The Antiquity of Caesarean Section with Maternal Survival: The Jewish Tradition, Medical History, 5, 2, 117–131, April 1961, 16562221, 1034600, 10.1017/S0025727300026089, Pliny the Elder 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.{{Citation |last1=Jauniaux |first1=Eric |title=Caesarean section |date=April 2016 |url=http://dx.doi.org/10.1093/med/9780198758563.003.0001 |work=Textbook of Caesarean Section |pages=9–24 |access-date=2023-08-19 |publisher=Oxford University Press |last2=Grobman |first2=William A.|doi=10.1093/med/9780198758563.003.0001 |isbn=978-0-19-875856-3 }} 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.WEB, 2013-10-25, The Truth About Julius Caesar and “Caesarean” Sections,www.todayifoundout.com/index.php/2013/10/caesarean-sections-named-emperor-julius-caesar/, 2020-10-09, Today I Found Out, en-US, The Spanish saint Raymond Nonnatus (1204–1240) received his surname—from the Latin (’not born’)—because he was born by caesarean section. His mother died while giving birth to him.WEB,www.catholic.org/saints/saint.php?saint_id=314, St. Raymond Nonnatus, Catholic Online, 26 July 2006, dead,www.catholic.org/saints/saint.php?saint_id=314," title="web.archive.org/web/20060719195735www.catholic.org/saints/saint.php?saint_id=314,">web.archive.org/web/20060719195735www.catholic.org/saints/saint.php?saint_id=314, 19 July 2006, There is some indirect evidence that the first caesarean section that was survived by both the mother and child was performed in Prague in 1337.JOURNAL, Pařízek A, DrÅ¡ka V, Říhová M, Prague 1337, the first successful caesarean section in which both mother and child survived may have occurred in the court of John of Luxembourg, King of Bohemia, Ceska Gynekologie, 81, 4, 321–330, Summer 2016, 27882755, NEWS,www.nytimes.com/2016/11/23/world/what-in-the-world/a-breakthrough-in-c-section-history-beatrice-of-bourbons-survival-in-1337.html, A Breakthrough in C-Section History: Beatrice of Bourbon’s Survival in 1337, de Goeij H, 23 November 2016, The New York Times, 29 December 2019, en-US, 0362-4331, 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 in Siegershausen, Switzerland, is supposed to have performed the operation 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.BOOK, United States Congress House Committee on Appropriations,books.google.com/books?id=Ixo4AAAAIAAJ&pg=PA539, Hearings, Reports and Prints of the House Committee on Appropriations, 1970, U.S. Government Printing Office, en, BOOK, Henry J, Doctors and Healers: Popular Culture and the Medical Profession, Pumphrey S, Rossi PL, Slawinski M, Science, Culture, and Popular Belief in Renaissance Europe, St. Martin’s Press, 1991, 0-7190-2925-2, New York, 197, {{Citation| vauthors = Sewell JE | url=https://www.nlm.nih.gov/hmd/pdf/cesarean.pdf|publisher=National Library on Medicine]|title=Cesarean Section: A Brief History | work = A Brochure to Accompany an Exhibition on the History of Cesarean Section at the National Library of Medicine |date=1993 |archive-url=www.nlm.nih.gov/hmd/pdf/cesarean.pdf" title="web.archive.org/web/20041105081735www.nlm.nih.gov/hmd/pdf/cesarean.pdf">web.archive.org/web/20041105081735www.nlm.nih.gov/hmd/pdf/cesarean.pdf |archive-date=2004-11-05}}For most of the time since the 16th century, the procedure had a high mortality rate. In Great Britain and Ireland, the mortality rate in 1865 was 85%. 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 first modern CS performed.
• The introduction of uterine suturing 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){{Clarify|date=January 2009}}
• Adherence to principles of asepsis
• Anesthesia advances
• Blood transfusion
• Antibiotics

Indigenous people in the Great Lakes region of Africa, including Rwanda and Uganda, performed caesarean sections which in one account by Robert William Felkin 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.WEB,www.nlm.nih.gov/exhibition/cesarean/part2.html, Cesarean Section â€“ A Brief History: Part 2, U.S. National Institutes of Health, 25 June 2009, 27 November 2010, live,www.nlm.nih.gov/exhibition/cesarean/part2.html," title="web.archive.org/web/20101221043816www.nlm.nih.gov/exhibition/cesarean/part2.html,">web.archive.org/web/20101221043816www.nlm.nih.gov/exhibition/cesarean/part2.html, 21 December 2010, BOOK, Ellwood RS, 1993, Islands of the Dawn: The Story of Alternative Spirituality in New Zealand, Honolulu, University of Hawaii Press, 0-8248-1487-8, JOURNAL, Dunn PM, Robert Felkin MD (1853-1926) and caesarean delivery in Central Africa (1879), Archives of Disease in Childhood. Fetal and Neonatal Edition, 80, 3, F250–F251, May 1999, 10212095, 1720922, 10.1136/fn.80.3.F250, James Barry was the first European doctor to carry out a successful caesarean in Africa, while posted to Cape Town between 1817 and 1828.WEB, Pain S, 6 March 2008,www.newscientist.com/article/mg19726462.000-histories-the-male-military-surgeon-who-wasnt.html, The ‘male’ military surgeon who wasn’t, NewScientist.com, 16 March 2008, live,www.newscientist.com/article/mg19726462.000-histories-the-male-military-surgeon-who-wasnt.html," title="web.archive.org/web/20080314230931www.newscientist.com/article/mg19726462.000-histories-the-male-military-surgeon-who-wasnt.html,">web.archive.org/web/20080314230931www.newscientist.com/article/mg19726462.000-histories-the-male-military-surgeon-who-wasnt.html, 14 March 2008, 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.MAGAZINE,www.time.com/time/magazine/article/0,9171,815000,00.html, Woman’s Ills, Time (magazine), Time, 1 April 2009, 18 June 1951, dead,www.time.com/time/magazine/article/0,9171,815000,00.html," title="web.archive.org/web/20090413025430www.time.com/time/magazine/article/0,9171,815000,00.html,">web.archive.org/web/20090413025430www.time.com/time/magazine/article/0,9171,815000,00.html, 13 April 2009,

Caesarius of Terracina

File:Icona Caesarius Diaconus, San Cesario diacono e martire.jpg|thumb|Saint Caesarius of Terracina, invoked for the success of caesarean delivery]]The patron saint of caesarean section is Caesarius, a young deacon martyred at Terracina, who has replaced and Christianized the pagan figure of Caesar.Caesarius Diaconus, testi e illustrazioni di Giovanni Guida, [s.l.: s.n.], 2015 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.Pasero Roberta, Cesareo di Terracina, un santo poco conosciuto: è il protettore del parto cesareo, in “DiPiù”, anno XIV, n° 48, 3 dicembre 2018.

Etymology

(File:Birth of Caesar.jpg|thumb|left|Fictional 15th-century depiction of the birth of Julius Caesar)The Roman Lex Regia (royal law), later the (imperial law), of Numa Pompilius (715–673 BC),BOOK, Segen JC, The Dictionary of Modern Medicine: A Sourcebook of Currently Used Medical Expressions, Jargon and Technical Terms,books.google.com/books?id=FbSlyyshjOoC&q=Caesarean+section+royal+law+Regia&pg=PA102, 7 December 2012, 1992, Taylor & Francis, 978-1-85070-321-1, 102, required the child of a mother who had died during childbirth to be cut from her womb.JOURNAL, Van Dongen PW, Caesarean section–etymology and early history., South African Journal of Obstetrics and Gynaecology, August 2009, 15, 2, 62–66,www.sajog.org.za/index.php/SAJOG/article/viewFile/158/117,www.sajog.org.za/index.php/SAJOG/article/viewFile/158/117," title="web.archive.org/web/20130515013653www.sajog.org.za/index.php/SAJOG/article/viewFile/158/117,">web.archive.org/web/20130515013653www.sajog.org.za/index.php/SAJOG/article/viewFile/158/117, 15 May 2013, There was a cultural taboo that mothers should not be buried pregnant,“As there was a cultural taboo against burying an undelivered woman in Roman and German societies, according to Lex Caesarea”. U Högberg, E Iregren, CH Siven, “Maternal deaths in medieval Sweden: an osteological and life table analysis”, Journal of Biosocial Science, 1987, 19: 495–503 Cambridge University Press 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.WEB, University of Virginia Health System, Claude Moore Sciences Health Library, Ancient Gynecology: Caesarean Section,www.hsl.virginia.edu/historical/artifacts/antiqua/gynecology.cfm,www.hsl.virginia.edu/historical/artifacts/antiqua/gynecology.cfm," title="web.archive.org/web/20130403133618www.hsl.virginia.edu/historical/artifacts/antiqua/gynecology.cfm,">web.archive.org/web/20130403133618www.hsl.virginia.edu/historical/artifacts/antiqua/gynecology.cfm, 3 April 2013, Speculations that the Roman dictator Julius Caesar was born by the method now known as C-section are false.Bad Medicine: Misconceptions and Misuses Revealed, by Christopher Wanjek, p. 5 (John Wiley & Sons, 2003) 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.“could not survive the trauma of a Caesarean” Oxford Classical Dictionary, Third Edition, “Childbirth” As late as the 12th century, scholar and physician Maimonides expresses doubt over the possibility of a woman’s surviving this procedure and again becoming pregnant.Commentary to Mishnah Bekhorot 8:2 The term has also been explained as deriving from the verb (wikt:caedere|caedere), ‘to cut’, with children delivered this way referred to as . Pliny the Elder 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 Caesar which was then carried by his descendants. Nonetheless, the false etymology has been widely repeated until recently. For example, the first (1888) and second (1989) editions of the Oxford English Dictionary say that caesarean birth “was done in the case of Julius Cæsar”.WEB, Oxford English Dictionary, 2nd, 1989,www.oed.com/oed2/00031110, s.v. Cæsarean, 2,web.archive.org/web/20200712123046/https://www.oed.com/oed2/00031110, 12 July 2020, More recent dictionaries are more diffident: the online edition of the OED (2021) mentions “the traditional belief that Julius Cæsar was delivered this way”,“most recently modified version published online March 2021” WEB, Oxford English Dictionary,www.oed.com/view/Entry/26016, s.v. Cæsarean, 2, and Merriam-Webster’s Collegiate Dictionary (2003) says “from the legendary association of such a delivery with the Roman cognomen Caesar”.{{citation | author = Merriam-Webster | author-link = Merriam-Webster | title = Merriam-Webster’s Collegiate Dictionary | edition = 11th | publisher = Merriam-Webster | year = 2003 | location = Springfield, Massachusetts, USA | isbn = 978-0-87779-809-5 | url =archive.org/details/merriamwebstersc00merr_6 }}The word Caesar, meaning either Julius Caesar or an emperor in general, is also borrowed or calqued in the name of the procedure in many other languages in Europe and beyond.For a summary, of an article about the relevant historical and linguistic questions, see WEB, Kaiserschnitt - Cäsars Geburtsgeschichte war ein historisches Missverständnis (W3),www.etymologie.info/~e/d_/de-medizi.html#Kaiserschnitt,www.etymologie.info/~e/d_/de-medizi.html," title="web.archive.org/web/20070106021301www.etymologie.info/~e/d_/de-medizi.html,">web.archive.org/web/20070106021301www.etymologie.info/~e/d_/de-medizi.html, 6 January 2007, Finally, the Roman praenomen (given name) Caeso was said to be given to children who were born via C-section. While this was probably just folk etymology made popular by Pliny the Elder, it was well known by the time the term came into common use.BOOK, Blumenfeld-Kosinski R, Not of Woman Born: Representations of Caesarean Birth in Medieval and Renaissance Culture, 1991, Cornell University Press, Ithaca, N.Y., 978-0-8014-9974-6, 1st, “Appendix: Creative Etymology: Caesarean Section from Pliny to Rousset” (pp. 143-153) presents a history of the legend of caesarean births in Western culture.

Spelling

{{See also|American and British English spelling differences}}The term caesarean is spelled in various accepted ways, (wikt:Caesarean#Alternative forms|as discussed at Wiktionary). The Medical Subject Headings (MeSH) of the United States National Library of Medicine (NLM) uses cesarean section,WEB,www.ncbi.nlm.nih.gov/mesh/68002585, Cesarean Section, en, while some other American medical works, e.g. Saunders Comprehensive Veterinary Dictionary, use caesarean,WEB,medical-dictionary.thefreedictionary.com/caesarean, Caesarean, as do most British works. The online versions of the US-published Merriam-Webster DictionaryWEB,www.merriam-webster.com/dictionary/cesarean, Definition of CESAREAN, 20 July 2023, and American Heritage Dictionary list cesarean first and other spellings as “variants”.

Society and culture

Presence of father

{{See also|Men’s role in childbirth}}In many hospitals, the mother’s partner is encouraged to attend the surgery to support her and share the experience.JOURNAL, Hugill K, Kemp I, Kingdon C, Fathers’ presence at caesarean section with general anaesthetic: evidence and debate, The Practising Midwife, 18, 4, 19–22, April 2015, 26328461, 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.WEB, ‘Gentle C-sections’: Bringing a traditional birth experience to the OR {{!, Your Pregnancy Matters {{!}} UT Southwestern Medical Center |url=http://utswmed.org/medblog/gentle-c-section/ |access-date=2023-07-13 |website=utswmed.org |language=en-us}}

Special cases

In Judaism, there is a dispute among the poskim (Rabbinic authorities) as to whether the first-born son from a caesarean section has the laws of a bechor.See Chok Yaakov 470:2; Kaf ha-Chayim 470:3; WEB,www.torah.org/advanced/weekly-halacha/5758/pesach.html, Weekly-Halacha, Pesach 5758 - Torah.org, 28 July 2010, dead,www.torah.org/advanced/weekly-halacha/5758/pesach.html," title="web.archive.org/web/20100818005722www.torah.org/advanced/weekly-halacha/5758/pesach.html,">web.archive.org/web/20100818005722www.torah.org/advanced/weekly-halacha/5758/pesach.html, 18 August 2010, Traditionally, a male child delivered by caesarean is not eligible for the Pidyon HaBen dedication ritual.WEB,judaism.about.com/od/lifeevents/g/pidyonhaben.htm, Pidyon HaBen â€” Definition of Pidyon HaBen (Redemption of the Firstborn), Judaism.about.com, 19 October 2012, dead,judaism.about.com/od/lifeevents/g/pidyonhaben.htm," title="web.archive.org/web/20111019184726judaism.about.com/od/lifeevents/g/pidyonhaben.htm,">web.archive.org/web/20111019184726judaism.about.com/od/lifeevents/g/pidyonhaben.htm, 19 October 2011, 15 August 2011, WEB,www.cohen-levi.org/the_cohens_heritage/pidyon_ha_ben.htm, Kohanim forever from the sources, who is a cohen, the blessing of the Cohanim,. Mitvah of the cohen, Halacha, Temple service groups, pidyon—redemption of the firstborn, Cohen-levi.org, dead,www.cohen-levi.org/the_cohens_heritage/pidyon_ha_ben.htm," title="web.archive.org/web/20110818124425www.cohen-levi.org/the_cohens_heritage/pidyon_ha_ben.htm,">web.archive.org/web/20110818124425www.cohen-levi.org/the_cohens_heritage/pidyon_ha_ben.htm, 18 August 2011, 15 August 2011, In rare cases, caesarean sections can be used to remove a dead fetus; otherwise, the woman has to labour and deliver a baby known to be a stillbirth. A late-term abortion using caesarean section procedures is termed a hysterotomy abortion and is very rarely performed.WEB, Casey FE, Spandorfer SD, 25 January 2022, Rivlin ME, Elective Abortion,emedicine.medscape.com/article/252560-overview, Medscape, 18 March 2016, live,www.emedicine.com/MED/topic3311.htm," title="web.archive.org/web/20041214092044www.emedicine.com/MED/topic3311.htm,">web.archive.org/web/20041214092044www.emedicine.com/MED/topic3311.htm, 14 December 2004, 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.NEWS,www.smh.com.au/articles/2004/06/01/1086037758224.html, True grit: the mum who delivered her own baby, The Sydney Morning Herald, 1 June 2004, 4 November 2010, live,www.smh.com.au/articles/2004/06/01/1086037758224.html," title="web.archive.org/web/20100718021023www.smh.com.au/articles/2004/06/01/1086037758224.html,">web.archive.org/web/20100718021023www.smh.com.au/articles/2004/06/01/1086037758224.html, 18 July 2010, JOURNAL, Molina-Sosa A, Galvan-Espinosa H, Gabriel-Guzman J, Valle RF, Self-inflicted cesarean section with maternal and fetal survival, International Journal of Gynaecology and Obstetrics, 84, 3, 287–290, March 2004, 15001385, 10.1016/j.ijgo.2003.08.018, 38220990, JOURNAL, Szabó A, Brockington I, Auto-Caesarean section: a review of 22 cases, Archives of Women’s Mental Health, 17, 1, 79–83, February 2014, 24318749, 10.1007/s00737-013-0398-z, 10641064, In 2024, a female western lowland gorilla had a successful cesarean section after zoo veterinarians diagnosed her with pre-eclampsia. The premature gorilla infant survived, as a result of similar methods used with human infants.NEWS, Yousef, Nadine, Texas zoo delivers baby gorilla via caesarean section,www.bbc.com/news/world-us-canada-68313089, BBC News, 17 February 2024, 18 February 2024,

References

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