Editing Caesarean section (section)

{{short description|Surgical procedure to deliver a baby through an incision in the mother's abdomen}}
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{{Use dmy dates|date=December 2019}}
{{Infobox medical intervention
| Name         = Caesarean section
| field        = [[Obstetrics]], [[gynaecology]], [[surgery]], [[neonatology]], [[pediatrics]], [[family medicine]]
| synonyms     = C-section, caesarean section, caesarean delivery
| Image        = Cesarian the moment of birth3.jpg
| Caption      = A team of five performing a caesarean section<ref>{{cite journal| vauthors = Fadhley S | title=Caesarean section photography|journal=[[WikiJournal of Medicine]]|date=2014|volume=1|issue=2|doi=10.15347/wjm/2014.006|doi-access=free}}
</ref>
|  ICD10       = 10D00Z0
|  ICD9        = {{ICD9proc|74}}
|  MeshID      = D002585
|  MedlinePlus = 002911
|  OPS301      =
|  OtherCodes  =
}}
<!-- Definition  and medical uses-->

'''Caesarean section''', also known as '''C-section''', cesarean, or '''caesarean delivery''', is the [[Surgery|surgical procedure]] by which one or more babies are [[Childbirth|delivered]] through an incision in the mother's abdomen. It is often performed because [[vaginal delivery]] would put the mother or child at risk (of paralysis or even death).<ref name="NIH2010">{{cite web|date=1 February 2017|title=Pregnancy Labor and Birth|url=https://www.womenshealth.gov/pregnancy/childbirth-and-beyond/labor-and-birth|url-status=live|archive-url=https://web.archive.org/web/20170728021055/https://www.womenshealth.gov/pregnancy/childbirth-and-beyond/labor-and-birth|archive-date=28 July 2017|access-date=15 July 2017|publisher=Office on Women's Health, U.S. Department of Health and Human Services}}{{PD-notice}}</ref> Reasons for the operation include, but are not limited to, [[obstructed labor]], [[twin pregnancy]], [[pre-eclampsia|high blood pressure]] in the mother, [[breech birth]], [[shoulder presentation]], and problems with the [[placenta]] or [[umbilical cord]].<ref name=NIH2010/><ref name=ACOG2014/> A caesarean delivery may be performed based upon the shape of the mother's [[pelvis]] or history of a previous C-section.<ref name=NIH2010/><ref name=ACOG2014/> A trial of [[Vaginal birth after previous C-section|vaginal birth after C-section]] may be possible.<ref name=NIH2010/> The [[World Health Organization]] recommends that caesarean section be performed only when medically necessary.<ref name="ACOG2014">{{cite web|date=March 2014|title=Safe prevention of the primary cesarean delivery|url=https://www.ajog.org/article/s0002-9378(14)00055-6/fulltext|access-date=26 March 2025|work=American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine}}</ref><ref name=WHO2015/>

<!-- Procedure -->
A C-section typically takes 45 minutes to an hour.<ref name=NIH2010/> It may be done with a [[spinal block]], where the woman is awake, or under [[general anesthesia]].<ref name=NIH2010/> A [[urinary catheter]] is used to drain the [[bladder]], and the skin of the [[abdomen]] is then cleaned with an [[antiseptic]].<ref name=NIH2010/> An [[Pfannenstiel incision|incision]] of about 15&nbsp;cm (6 inches) is then typically made through the mother's lower abdomen.<ref name=NIH2010/> The [[uterus]] is then opened with a second incision and the baby delivered.<ref name=NIH2010/> The incisions are then [[surgical suture|stitched]] closed.<ref name=NIH2010/> A woman can typically begin [[breastfeeding]] as soon as she is out of the [[operating room]] and awake.<ref>{{cite book| vauthors = Lauwers J, Swisher A | chapter = Hospital Practices that Support Breast Feeding |title=Counseling the Nursing Mother: A Lactation Consultant's Guide|date=2010|publisher=Jones & Bartlett Publishers |isbn=978-1-4496-1948-0|page=274| chapter-url=https://books.google.com/books?id=2X0_Takcr_wC&pg=PA274|language=en|url-status=live|archive-url=https://web.archive.org/web/20170911003217/https://books.google.com/books?id=2X0_Takcr_wC&pg=PA274|archive-date=11 September 2017}}</ref> Often, several days are required in the hospital to recover sufficiently to return home.<ref name=NIH2010/>

<!-- Risks -->
C-sections result in a small overall increase in poor outcomes in low-risk pregnancies.<ref name=ACOG2014/> They also typically take about six weeks to heal from, longer than vaginal birth.<ref name=NIH2010/> The increased risks include breathing problems in the baby and [[amniotic fluid embolism]] and [[postpartum bleeding]] in the mother.<ref name=ACOG2014/> Established guidelines recommend that caesarean sections not be used before 39 [[Gestational age (obstetrics)|weeks of pregnancy]] without a medical reason.<ref name="ACOGfive">{{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 = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |access-date = 1 August 2013 |url-status = live |archive-url = https://web.archive.org/web/20130901094916/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-obstetricians-and-gynecologists/ |archive-date = 1 September 2013 }}</ref> The method of delivery does not appear to affect subsequent [[sexual function]].<ref>{{cite journal | vauthors = Yeniel AO, Petri E | title = Pregnancy, childbirth, and sexual function: perceptions and facts | journal = International Urogynecology Journal | volume = 25 | issue = 1 | pages = 5–14 | date = January 2014 | pmid = 23812577 | doi = 10.1007/s00192-013-2118-7 | s2cid = 2638969 }}</ref>

<!-- Epidemiology -->
In 2012, about 23 million C-sections were done globally.<ref name=Mol2015/> The international healthcare community has previously considered the rate of 10% and 15% ideal for caesarean sections.<ref name=WHO2015>{{cite web|title=WHO Statement on Caesarean Section Rates|url=http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf|access-date=6 May 2015|date=2015|url-status=live|archive-url=https://web.archive.org/web/20150501002853/http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15.02_eng.pdf|archive-date=1 May 2015}}</ref> Some evidence finds a higher rate of 19% may result in better outcomes.<ref name=Mol2015>{{cite journal | vauthors = Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, Shah N, Semrau K, Berry WR, Gawande AA, Haynes AB | title = Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality | journal = JAMA | volume = 314 | issue = 21 | pages = 2263–2270 | date = December 2015 | pmid = 26624825 | doi = 10.1001/jama.2015.15553 | doi-access = free }}</ref> More than 45 countries globally have C-section rates less than 7.5%, while more than 50 have rates greater than 27%.<ref name=Mol2015/> Efforts are being made to both improve access to and reduce the use of C-section.<ref name=Mol2015/> In the United States as of 2017, about 32% of deliveries are by C-section.<ref>{{cite web|title=Births: Provisional Data for 2017|url=https://www.cdc.gov/nchs/data/vsrr/report004.pdf |archive-url=https://web.archive.org/web/20180517190023/https://www.cdc.gov/nchs/data/vsrr/report004.pdf |archive-date=2018-05-17 |url-status=live|website=CDC|access-date=18 May 2018|date=May 2018}}</ref> 

<!-- history -->
The surgery has been performed at least as far back as 715 BC following the death of the mother, with the baby occasionally surviving.<ref name=Mor2004/> 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 (mother of Caesar)|Aurelia]] not only survived her son's birth but lived for nearly 50 years afterward.<ref name=":0">{{Cite journal |last=Meehan |first=F. P. |date=January 1988 |title=Caesarean section-past, present and what of the future? |url=http://dx.doi.org/10.3109/01443618809012284 |journal=Journal of Obstetrics and Gynaecology |volume=8 |issue=3 |pages=201–205 |doi=10.3109/01443618809012284 |issn=0144-3615|url-access=subscription }}</ref><ref>{{Cite web |title=Cesarean Section - A Brief History preface |url=https://www.nlm.nih.gov/exhibition/cesarean/preface.html |access-date=2024-03-14 |website=www.nlm.nih.gov}}</ref> 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.<ref name="Dhakal-Rai e1–e10">{{Cite journal |last1=Dhakal-Rai |first1=Sulochana |last2=van Teijlingen |first2=Edwin |last3=Regmi |first3=P. |last4=Wood |first4=Juliet |last5=Dangal |first5=G. |last6=Dhakal |first6=K. B. |date=2021-10-10 |title=A brief history and indications for cesarean section |url=https://eprints.bournemouth.ac.uk/36095/ |journal=Journal of Patan Academy of Health Sciences |language=en |volume=8 |issue=3 |pages=e1–e10 |doi=10.3126/jpahs.v8i3.27657 |issn=2091-2749|doi-access=free }}</ref><ref>{{Cite journal |last=Hillan |first=E M |date=October 1991 |title=Caesarean Section: Historical Background |url=http://journals.sagepub.com/doi/10.1177/003693309103600511 |journal=Scottish Medical Journal |language=en |volume=36 |issue=5 |pages=150–154 |doi=10.1177/003693309103600511 |pmid=1788548 |issn=0036-9330|url-access=subscription }}</ref> 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.<ref name="Dhakal-Rai e1–e10"/> With the introduction of antiseptics and [[anesthetics]] in the 19th century, the survival of both the mother and baby, and thus the procedure, became significantly more common.<ref name=Mor2004>{{cite book| vauthors = Moore MC, de Costa C | chapter = A Brief History of Cesarean Section |title=Cesarean Section: Understanding and Celebrating Your Baby's Birth|date=2004|publisher=JHU Press|isbn=978-0-8018-8133-6 |page= 31| chapter-url=https://books.google.com/books?id=Slf7Rp1zG6YC&pg=PT31|language=en}}</ref><ref>{{Cite web|url=http://www.todayifoundout.com/index.php/2013/10/caesarean-sections-named-emperor-julius-caesar|title = The Truth About Julius Caesar and "Caesarean" Sections|date = 25 October 2013}}</ref>
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