First of all let’s clarify what a caesarean delivery or birth is. It has been long thought that the word caesarean originated because the Roman emperor Julius Caesar was the first baby to be born by caesarean section. But there is some disagreement about this – perhaps he was and maybe he wasn’t. This may just be one of those fables which sounds as if it could be true, lending some authority to it.
But what is clear is that the word caesarean is derived from the Latin word caedo which means “to cut”. And this is precisely what happens during a caesarean.
This is an operation which allows a baby to be born through a cut made into their mother’s abdominal wall and uterus. During a normal delivery a baby is born as it comes out through the mother’s vagina, but with a caesarean section delivery the baby is born as it comes through a surgical incision or cut which has been made into the mother’s abdomen.
A caesarean can be either planned, otherwise known as elective; or unplanned, otherwise known as an emergency caesarean. Another name for an elective caesarean delivery may be “on maternal request” as this can also be done in the absence of any maternal or foetal indications.
If vaginal birth is considered risky and problems are detected early, then a planned/elective caesarean section may be considered. An emergency caesarean section tends to occur when there are problems once labour has already started.
Many reasons contribute to why a caesarean section may be unplanned or an emergency. It’s not uncommon for women who have intended to give birth vaginally to find they need an emergency caesarean delivery once their labour has already started. Their own health or that of their baby’s may become compromised by a vaginal birth.
For some mothers especially, this can become a real disappointment. What was intended and planned for did not eventuate and it can take time and in some cases, even supportive counselling to come to terms with. But this can also be the case with an elective caesarean section delivery. If mothers are advised reasonably early in their pregnancy that a caesarean is likely then they have more time to become used to the idea.
It is important to remember that not all women with the following conditions will need a caesarean delivery. Every woman and her pregnancy are unique and individual circumstances must be considered when considering birth options.
Some women are genuinely scared of having a vaginal delivery. They can be very strong self advocates for having a caesarean although there may not be a physical reason why they cannot have a vaginal birth. In this case many factors need to be carefully weighed up.
Caesarean section is not without risk, and scientific evidence shows that a vaginal delivery is generally the safest mode of childbirth.
Prenatal counselling is sometimes considered necessary for women who are genuinely fearful of having a vaginal birth. Referral to a psychologist or counsellor with specialised skills in obstetrics and maternity care can be very useful.
Writing up a realistic birth plan, ensuring emotional support during labour and delivery and planning for pain relief can make a big difference towards looking forward to childbirth rather than fearing it. Though it is fair to say that for some women, no amount of counselling or ante-natal support can allay anxiety surrounding their baby’s birth.
Individual risk factors can add complexity to whether a caesarean section is the safest way for a baby to be born. There is no prescriptive “one size answer” to why and when a caesarean may be necessary.
It’s important to:
Most caesarean section incisions (cuts) are made horizontally in the lower segment of the mother’s uterus. This is known as a “bikini line” cut. This is a preferred incision as it creates fewer problems with subsequent pregnancies and birth.
But sometimes a vertical incision in the mother’s uterus is necessary if the baby needs to be delivered very quickly or the placenta is adhered very low to the uterus. Another name for this is a classical incision.
The cut on the mother’s abdomen may still be horizontal but the cut on the uterus is vertical. If you are unsure then ask the doctor who has done the caesarean. This may be important if you change your maternity care provider for subsequent pregnancies.
Although the risks are considered small, especially with current day surgical techniques, caesarean section delivery does pose different risks when compared with a vaginal birth.
It is important to remember that many factors contribute to the decision whether a caesarean delivery is needed. Every woman and her baby are unique. If you are in any doubt, speak with your doctor and/or maternity care provider about what is right for you.
Written for Huggies by Jane Barry-Midwife and Child Health Nurse and director of www.mybabybaby.com.au