Caesarean sections

Caesarean section (also known as C-section or cesarean delivery) is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. It is often performed when a vaginal delivery would put the baby or mother at risk. This may include several medical conditions such as obstructed labor, twin pregnancy, high blood pressure in the mother, or fetal distress. Caesarean sections are also performed upon request for non-medical reasons.

Indications

The primary indications for a Caesarean section include, but are not limited to, obstructed labor, fetal distress, multiple pregnancies, placenta previa, and pre-eclampsia. Obstructed labor occurs when the baby cannot pass through the birth canal due to its size or position. Fetal distress is when the fetus is not well, often indicated by an abnormal heart rate. Multiple pregnancies, especially triplets or more, often lead to a recommendation for a C-section. Placenta previa is a condition where the placenta covers the opening of the uterus, blocking the baby's exit during vaginal delivery. Pre-eclampsia is a condition characterized by high blood pressure and often liver or kidney damage in the mother, which can be life-threatening for both the mother and the fetus.

Procedure

A Caesarean section involves two main incisions. The first is an abdominal incision, which can be either a vertical incision from the navel to the pubic hair (classical Caesarean) or a horizontal incision above the pubic hairline (lower segment Caesarean, which is more common due to its reduced bleeding and better healing). The second incision is made in the uterus. The baby and the placenta are then removed, and the incisions are closed with sutures.

Risks

While a Caesarean section is generally considered safe, it carries a higher risk than vaginal delivery. These risks include infection, postpartum hemorrhage, reactions to anesthesia, and blood clots. Long-term risks include an increased risk of placenta previa and placental abruption in future pregnancies. The baby may also experience breathing problems, although this is more common in elective C-sections before 39 weeks of gestation.

Recovery

Recovery from a Caesarean section typically involves a longer hospital stay and a longer period of physical recovery compared to vaginal birth. Pain and discomfort in the incision area are common, and activities such as driving and lifting heavy objects are restricted to allow the incision to heal.

Epidemiology

The rate of Caesarean sections has been increasing globally, with significant variations between countries. Factors contributing to this increase include the rise in maternal age, obesity, diabetes, and the use of interventions such as induction of labor.

Controversy

There is ongoing debate about the high rate of Caesarean sections in some countries and the potential for unnecessary C-sections. Concerns have been raised about the long-term health implications for both mothers and children, as well as the increased healthcare costs.