By Isabel Moragues MD, PhD, MSc (senior embryologist).
Last Update: 07/15/2014

There is a general trend to perform a C-section, being in most of the cases completely unnecessary. Twenty two per cent of cesarean deliveries are performed annually in Spanish public hospitals, figures which skyrocket up to 43% in private hospitals. We should therefore be informed about what a caesarean is.

The different sections of this article have been assembled into the following table of contents.

Definition

A caesarean section is a surgical procedure in which a baby is born through the abdomen of the mother. Two abdominal incisions are performed: one is called laparotomy and reaches the uterus, the other is the hysterectomy and is performed in the uterus. This kind of intervention requires epidural anesthesia, which means that the mother is awake during the whole process.

Historical records show that Julius Caesar was born through that procedure, hence the name.

The incision is to be performed transversally in the lower abdomen. It is an horizontal section just below the pubic bones, so that it is as aesthetic for the mother as possible despite the technical difficulty. This incision is known as bikini cut. It can also be made vertically, i.e. zip-like; but it is not as aesthetically pleasant as the former.

Another advantage of the lower transversal incision is the possibility of having future vaginal deliveries.

Today’s surgery has experienced great developments and changes, and the process may last just 15 to 20 minutes approximately, including the placenta extraction through the same incision.

The relative safety of this intervention has made us forget about its risks, increasing the number of caesarean births up to an average of 20%, way above the recommendations given by the World Health Organisation (WHO).

Indications for caesarean

As in any other surgical intervention to be made in the operation room, there are risks and complications that may damage the mother’s state of health and even increases the risk of maternal mortality. That is the reason why this procedure is only to be made under medical supervision. In our post Normal delivery or caesarean? we go over this topic in detail.

The situations in which a caesarean would be advisable are the following:

  • Breech births or transversal placements of the body.
  • If the mother has undergone previous interventions in the uterus or caesareans.
  • If the newborn is too large.
  • Placenta previa.
  • If the delivery has stopped or is not progressing.
  • Prolapse in the umbilical cord or the newborn has the cord tied to the neck.
  • If the mother has an infection susceptible to be transmitted to the newborn through the birth canal (vertical transmission), like HIV or herpes.
  • If the newborn has bradychardia (decreased heart rate) or any other stress that indicates fetal suffering.
  • If the mother suffers diabetes, hypertension or any other disease that requires a rapid delivery.

When a caesarean is performed, the benefits have to surpass the risks.

Caesarean may be programmed, which is known as elective caesarean. It is programmed between the 37th and 38th week of gestation, assuring the unborn is developed enough.

There are three types of caesarean: programmed caesarean, emergency caesarean, and caesarean during delivery.

We need to bear in mind that even though the caesarean is a relatively safe procedure, it is still a surgical intervention with some risks associated.

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Authors and contributors

 Isabel Moragues
MD, PhD, MSc
Senior Embryologist
Bachelor's Degree in Biology and Biochemistry from the Universities of Alicante and Miguel Hernández of Elche. PhD with Cum Laude distinction in Biological Sciences from the University of Alicante. Master's Degree in Human Reproduction Biology from the Miguel Hernández University of Elche. Senior Embryologist and Specialist in Clinical Genetics with more than 15 years of experience. Director of IVF laboratories in various private fertility clinics. More information
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One comment

    1. Mariah

      During my whole pregnancy, I prayed so that I had a natural, easy delivery. However, when the day arrived, a caesarean had to be performed. But the truth is that it was wonderful. I didn’t suffer a lot with the removal o the stitches.Now, I just have a small scar.