Caesarean section, or C-section as it is commonly known, is a method of delivering a baby through an incision made in the mother’s lower abdominal wall and uterus instead of delivery through the vagina. The origins of the name are unclear. Although widely believed to be named for Julius Caesar, it is unlikely that this surgical procedure was used at the time of his birth. It may have been so named because of a law, enacted under Julius Caesar’s rule, which required this form of birth when a mother was sick or dying.

According to the Centers for Disease Control and Prevention (CDC), there are more than 700,000 first-time C-sections and 400,000 repeat Caesarean deliveries each year. The total number of C-sections accounted for approximately 29 percent of all births during 2004, the highest rate ever reported in the United States. The following table shows a further breakdown of each type of delivery:

Source: CDC’s National Center for Health Statistics

Caesarean delivery has generated a great deal of debate. Some experts believe that this form of delivery is overused and places the mother and baby at unnecessary risk for surgical or delivery-related complications. According to the CDC, C-section rates have been rising since 1996, and in 2004 the highest percentage of C-sections ever in the United States were performed. In a study conducted by the U.S. Agency for Healthcare Research, C-section was determined to be the most common hospital procedure in the United States. The surgeries were estimated to cost a total of 14.6 billion dollars in 2003.

In many cases, it is the patient who requests a Caesarean section. A growing number of expectant mothers are choosing a C-section in an effort to avoid future pelvic support or sexual dysfunction problems, as well as for other reasons. Between 2001 and 2003, the rate of C-sections performed due to patient-choice increased by nearly twice as much as those performed between 1999 and 2001.

A physician is said to be ethically justified in performing the procedure, called “patient choice Caesarean” or “Caesarean on demand,” as long as it poses no additional risk to the mother or her unborn child, according to the American College of Obstetricians and Gynecologists (ACOG). However, if the procedure would not promote the overall health and welfare of the patient and her fetus, then the physician is ethically obligated to abstain from the procedure.

In most cases, the Caesarean section is used only after the obstetrician has carefully considered the patient’s individual condition in relation to the pregnancy and has determined that it is medically necessary. This determination may be made at any time during the patient’s prenatal visits, but most often is evident only after labor begins.

There are many reasons that an obstetrician may determine that a Caesarean delivery is advisable for a healthy and safe delivery. Most reasons are related to the status of the baby, while others have more to do with the mother. In general, the most common reasons for a C-section include:

Reasons related to the baby:

• Abnormal presentation. This includes situations such as when a baby is breech (entering the birth canal upside down – either feet or buttocks first) or transverse (shoulders or side first). Some breech babies can be manually turned to the head down position by the obstetrician (a process called external cephalic version).
  
  
• Prolapsed umbilical cord. When the umbilical cord enters the vagina before the baby during labor it creates a risk of strangulation or possibly block the progress of a vaginal delivery.
  
  
• Placenta previa. At times, the placenta (organ that connects the mother and her baby) drops so low in the uterus that there is a risk that it can block the cervix and keep the baby from passing easily through the birth canal. Placenta previa can also lead to hemorrhaging (severe bleeding). This condition is more common among expectant mothers who smoke, use cocaine or are over the age of 35 years. In addition, the scar created by the surgical incision during a C-section can increase the risk of placenta previa in future pregnancies.
  
  
• Placenta abruptio. At times, it is possible for the placenta to disengage from the uterine wall just before delivery, which can cause the baby to have an abnormal heart rate and the mother to hemorrhage. New research also finds a link between C-section deliveries and placenta abruptio in later pregnancies. In addition, the risk of both placenta previa and placenta abruptio is greater if a second pregnancy occurs within a year of a Caesarean delivery.
  
  
• Developmental abnormalities. In the case of a baby that has birth defects, such as hydrocephalus (a condition where cerebrospinal fluid collects on the brain and may result in an enlarged head) or spina bifida, a C-section may be indicated.
  
  
• Fetal distress. When the baby has an abnormal heart rate pattern – either too slow or too rapid.
  
  
• Multiple births. In the case of twins or triplets (or more), a Caesarean section is often considered a safer method of delivery.

Reasons related to the mother:

• Maternal illness. Certain diseases and conditions in the mother may indicate the need for a C-section. Some examples include:
  
• • High blood pressure (hypertension)
    
    
  • Heart disease
    
    
  • Preeclampsia or eclampsia
    
    
  • Gestational diabetes
    
    
  • Genital herpes outbreak at the time of delivery
    
    
  • Maternal HIV infection
    
    
  • Ovarian or uterine cysts or tumors
    
    
  • Previous Caesarean delivery. Previous surgery in the uterus, including C-section and myomectomy. However, a woman who has had a C-section may still be able to deliver vaginally for subsequent pregnancies.
    
    
• Placenta accreta. Rarely, the placenta will attach deeply to the wall of the uterus. This condition is dangerous to the health of the mother. A history of multiple Caesarean deliveries increases the risk. This condition frequently remains undiagnosed before delivery and, although rare, can result in excessive bleeding and the need for a hysterectomy to be performed at the time of delivery.
  
  
• Prolonged or ineffective labor. A C-section may be performed in the case of prolonged or arrested labor, such as insufficient contractions of the uterus or if the cervix does not dilate sufficiently. Physicians’ opinions differ in the determination of what constitutes a prolonged or ineffective labor.
  
  
• Cephalopelvic disproportion. This is a condition in which the baby’s head is too large or the mother’s birth canal or pelvis is not large enough to ensure a safe vaginal delivery.
  
  
• Polyhydramnios. This condition is characterized as a pregnant woman having too much amniotic fluid. In many cases, polyhydramnios will go away by itself. When that does not occur, women with this condition are more likely to have a C-section.
  
  
• Oligohydramnios. This condition is characterized as a pregnant woman having too little amniotic fluid. In some cases where this condition is causing fetal distress, a C-section may be necessary.