UNSW Embryology

Normal Development- Birth - Caesarean Delivery

© Dr Mark Hill (2008)

Acknowledgements

Introduction

The term "caesarean" comes from the historic description of Julius Ceasar's birth, though probably ficticious as his mother Aurelia survived his birth. The procedure involves surgically cutting skin, abdominal wall and uterus to allow abdominal delivery. (More? watch Video Webcast of Cesarean)

Image modified from JAMA Information sheet

The rate of caesarean delivery compared to normal vaginal birth is variable between countries (12-25%, 20% of all births in Australia) and increasing, particularly in older women. There are a number of different explanations as to why this is occuring, including maternal or fetal complications of either development or delivery.

Importantly this is a maternal surgical procedure which requires time for recovery and there are several studies that have looked also into the effects of caesarean delivery on potential future normal vaginal births.

Some Recent Findings

Caesarean Medical Reasons

Listed below are the main medical resons for considering a Caesarean.

If your baby is positioned bottom first
If you have a viral infection
If you are expecting twins
If your baby is small
If your baby is premature

Caesarean Standard Categories

Where there is an immediate threat to your life or the life of your baby
Where there is concern about your health or the health of your baby, but your lives are not in immediate danger
Where there is no immediate concern about your health or the health of your baby, but you need an early delivery because of an existing condition
Where delivery is timed to suit you or your healthcare team

(Based on NHS pamphlet April 2004 - Understanding National Institute for Clinical Excellence Guidance – Information for pregnant women, their partners and the public)

Caesarean Data (UK)

Image from: The National Sentinel Caesarean Section Audit Report (UK)

A UK national audit of the caesarean section rate, based on a snapshot of births in maternity units during a three month period, has shown that the overall rate for England and Wales is now 21.5% That compares with a rate in England of 4% some 30 years ago.

England was in the 1970s, when it doubled from 4% in 1970 to 9% by the end of the decade. By 1995, the rate was estimated to be 16% and in 1999 to be 19%

Factors associated with caesarean section rates included demographic changes, women's choices about childbirth, and the views of obstetricians.

BMJ 2001;323:951 ( 27 October) Caesarean section rate in England and Wales hits 21 by Roger Dobson.

The national sentinel caesarean section audit, carried out by the clinical effectiveness support unit of the Royal College of Obstetricians and Gynaecologists

Royal College of Obstetricians and Gynaecologists (UK)

References

Search Pubmed Now: caesarean[TITL] (2005: 2969 Articles, 108 Reviews)

Reviews

Horey D, Weaver J, Russell H. [See Related Articles] Information for pregnant women about caesarean birth. Cochrane Database Syst Rev. 2004;(1):CD003858. Review.
Baston H. [See Related Articles] Midwifery basics: postnatal care. Post-operative care following caesarean. Pract Midwife. 2005 Feb;8(2):32-6. Review.
Anderson ER, Gates S. [See Related Articles] Techniques and materials for closure of the abdominal wall in caesarean section. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004663. Review.
Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. [See Related Articles] Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004224. Review.
Liu EH, Sia AT. [See Related Articles] Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ. 2004 Jun 12;328(7453):1410.
Brill Y, Windrim R. [See Related Articles] Vaginal birth after Caesarean section: review of antenatal predictors of success. J Obstet Gynaecol Can. 2003 Apr;25(4):275-86. Review.

Articles

Smith GC, White IR, Pell JP, Dobbie R. [See Related Articles] Predicting Cesarean Section and Uterine Rupture among Women Attempting Vaginal Birth after Prior Cesarean Section. PLoS Med. 2005 Sep 13;2(9)

WWW Links

Video Webcast Cesarean Hartford Hospital Cesarean Childbirth (September 23rd, 2005)

electronic Med J AustCaesarean section: a matter of choice? by de Costa, C.M. MJA 1999; 170: 572-573

Mayo Clinic (USA) Caesarean delivery: When is it the best option?

JAMA Patient Page: Cesarean Delivery (USA) Journal of American Medical Association - one page Caesarean delivery information sheet (PDF)

Babycentre Information (UK) Are the caesarean section rates too high? Why might I need a caesarean section? What happens during a caesarean? Can I minimise my chances of having a caesarean birth? I had my first child by caesarean. Can I deliver my next baby vaginally?

British Library (UK) Images online Birth of Julius Caesar (French - late 14th century)

OBGYN Net History of Cesarean Section an excellent description by Dr Magnus Murphy of the historic background of this surgical procedure.