September 1, 2008
Caesarean sections (C-sections) have had a long and sometimes controversial history. Although seen as a more recent development, its origins date back millennia. From previously being considered a “last ditch resort” they are now performed with such frequency that many view them as routine.
Why they are called “Caesareans” remains a matter of debate. It most likely results from the Lex Caesare which dictated that in the event of a pregnant woman dying during labour, the foetus must be extracted as quickly as possible via abdominal incision. However, it is known that the surgical procedure itself dates back into the origins of recorded history. According to Greek mythology, Apollo took Asclepius from his dead mother’s abdomen.
Several different techniques have been used, but the early 20th century lower transverse incision introduced by German obstetrician Pfannenstiel remains the most popular to date.
The number of women undergoing surgical deliveries has reached alarming proportions. According to the latest figures, on average, 25% of babies are currently born by C-section. The World Health Organization states that no region in the world is justified in having a C-section rate greater than 15%. These figures have raised worldwide concern regarding the appropriateness of current C-section practice.
The medical indications for an elective (i.e. planned) caesarean are:
- Preeclampsia of the mother
- Placental abnormalities (abruption , placenta previa)
- Breech position of the fetus
- Cephalopelvic disproportion
- Genital Herpes
- Life threatening congenital abnormalities
The reasons postulated for C-sections performed other than for maternal or foetal wellbeing are, among others, avoidance of labor pain, protection of the pelvic floor, patient or provider convenience, legal concerns of the provider etc. It is interesting to note that the incidence of C-sections has been found to be significantly higher if private insurance is the expected source of payment.
A C-section not only costs significantly more than a vaginal delivery (including prolonged recovery) but according to a recent Lancet study, women are three times more likely to die during a C-section than during a normal delivery. Haemorrhage, infection, paralytic ileus, pulmonary embolism, respiratory distress of the newborn and adverse effects on future pregnancies are only a few of the possible consequences of a C-section.
All surgical interventions carry risks and must therefore be clinically justified, and informed consent must be sought from the patient, who has the right to refuse the intervention, even if this could result in harm or death. However, a distinction needs to be made between this negative right and the positive right to insist upon treatment that the doctor is obliged to provide. There is no question that lives can be saved by the judicious use of C-sections, but in a world of modern resources and multiple sites of medical training, this development is not a sign of progress but rather of misplaced priorities. Why should a natural process be replaced with a major surgical procedure?
International Healthcare News from Dr. Ulli //