C-sections: Then and now

May 19, 1999
Web posted at: 5:01 PM EDT (2101 GMT)

In this story: Early history Huge increase until the 1990s Hope for fewer C-sections Initiative for vaginal birth Making birth easier RELATEDS

By Stephanie Slon

(WebMD) -- There's nothing new about cesarean sections. Surgical birth is mentioned in the ancient folklore of both Eastern and Western cultures. However, the reasons for the operation as well as its techniques and success rates have evolved dramatically over the centuries.

Early history

The earliest use of cesarean-section surgery was extracting a fetus from a dead or dying mother. This was done primarily to fulfill religious doctrines requiring that the child, who was unlikely to survive, be buried separately. In the 1500s a Swiss farmer -- whose only surgical experience was neutering pigs -- carried out the first recorded cesarean section in which both the mother and baby survived. C-sections continued to be performed over the next few centuries but with almost universally grim outcomes; one estimate calculates that between 1787 and 1876 not a single Parisian woman survived the surgery.

Huge increase until the 1990s

By the middle of this century innovations in anesthesia, antiseptic practices, and antibiotics -- coupled with the rise of hospital-based deliveries -- established cesarean birth as a safe procedure. However, the C-section continued to be uncommon until the 1980s, when it grew to represent nearly a quarter of all deliveries. This high water mark was a fivefold increase from only the previous decade. Interestingly, the rise in the C-section rate itself was a major element in pushing the numbers up: Until the 1990s doctors lived by the dictum "Once a C-section, always a C-section."

The C-section rate in this country has come under intense scrutiny since it reached its peak in 1988. Critics have expressed alarm at the frequency of the procedure. Although it can save lives, a cesarian is major abdominal surgery that opens the mother to the risks of infection, blood loss, and even death. For the baby, premature birth, low birth weight, and breathing problems are all possible risks. Moreover, the cost of the operation is nearly double that of a vaginal birth.

Hope for fewer C-sections

The U.S. Department of Health and Human Services has targeted a 15 percent cesarean delivery rate by the end of this century. This is also the number the World Health Organization finds acceptable; most other industrialized nations are well within this limit. In the United States, cesarean sections reached a low of 20.8 percent in 1995 but climbed again to 21.5 percent the following year, making the 15 percent goal unlikely by 2000.

Initiative for vaginal birth

Since about a third of C-sections are repeat operations, there is a major initiative under way encouraging women to attempt a vaginal birth (VBAC) if they've had a cesarean. This is possible because the low, horizontal incision currently used in C-sections doesn't carry the danger of rupturing the uterus with subsequent labors, as did the older surgical technique. The American College of Obstetricians and Gynecologists endorses VBAC as the preferred birth method after one and possibly even two or more C-sections.

The efforts to popularize VBAC are beginning to pay off. In 1995, 35.5 percent of women with previous cesareans gave birth vaginally -- more than five times the number of VBACs in 1985. There is still room for improvement, however. Some estimates say as many as 80 percent of women who have had cesareans are capable of having a safe VBAC.

Making birth easier

The real challenge, of course, lies in limiting the number of first-time C-sections. In a certain percentage of cases a cesarean is unavoidable -- for example, when labor is halted, the baby is in breech position, or there are signs of serious fetal distress. There is also new evidence that a cesarean delivery prevents the transmission of HIV infection from mother to child.

Under normal circumstances, however, a woman improves her chances of an uncomplicated birth by educating herself about the birth process and being up-front with her providers about how much medical intervention she finds acceptable. Studies have also demonstrated that enlisting the aid of a nonmedical labor support person, called a doula, can significantly reduce the likelihood of a C-section.

RELATEDS AT :

Vaginal Birth after Cesarean
Labor and Delivery

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