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Caesarean Section

Julius Caesar was purportedly delivered from his dead mother, alive and well, after her belly was cut open immediately upon her demise, giving rise to the common name for the operative delivery of a baby. In the last 2000 years the operation has been considerably refined to the point where about a quarter of all babies are now delivered in this manner.

There are obvious situations where a caesarean section is the only choice for the obstetrician. These include a baby that is presenting side on instead of head first, a placenta (afterbirth) that is over the birth canal, a severely ill mother, a distressed infant that may not survive the rigors of the passage through the birth canal, and the woman who has been laboring for many hours with no success.

Caesarean sections may also be performed if the mother has had a previous operative birth, if she is very small, if previous children have had birth injuries or required forceps delivery, for a baby presenting bottom first, if the baby is very premature or delicate, in multiple pregnancies where the two or more babies may become entangled, and in a host of other combinations and permutations of circumstances that cannot be imagined in advance. The decision to undertake the operation is often difficult, but it will always have to be up to the judgment and clinical acumen of the obstetrician, in consultation with the mother if possible, to make the final decision.

The operation is extremely safe for both mother and child. A spinal or epidural anesthetic is given to the mother, and the baby is usually delivered within five minutes. A general anesthetic is these days only given in some specific circumstances. After delivery the longer and more complex task of repairing the womb and abdominal muscles is undertaken. In most cases, the scar of a caesarean is low and horizontal, below the bikini line, to avoid any disfigurement.

With epidural or spinal anesthesia, a needle is placed in the middle of the mother's back, and through this an anesthetic is introduced. The woman feels nothing below the waist, and although sedated is quite awake and

able to participate in the birth of her baby, seeing it only seconds after it is delivered by the surgeon. Some doctors and hospitals allow the woman's partner to be present during these deliveries.

Recovery from a caesarean is slower than for normal childbirth, but most women leave hospital within seven days. It does not affect breast feeding or the chances of future pregnancies, and does not increase the risk of miscarriage.