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Cesarean Birth
Description
Cesarean birth (or cesarean section) is the delivery of the fetus through surgical incisions in the mother’s abdomen and uterus. The rate of cesarean birth varies from 10% to 35% around the world, influenced by cultural factors and the availability of surgical care. In the United States, the rate of cesarean births increased by 5-fold for a 20-year period that ended in the early 1990s. The exact reasons for this are open to conjecture, but concerns about liability, almost universal use of electronic fetal monitoring, increasing birthweight, and an increased number of repeat cesarean deliveries have all been postulated. The rate of cesarean delivery in the United States is 31.8% (2020). Despite this increase, only minor improvements in newborn outcomes have occurred as a result.
Indications
Cesarean birth may be selected to accomplish fetal delivery when it is impossible, impractical, or unsafe for the baby to be vaginally delivered. Acute indications for cesarean birth include fetal distress, hemorrhage from placenta previa, placental abruption, prolapse of the umbilical cord, and uterine rupture because these conditions require prompt delivery. Fetal intolerance to labor or failure of the labor to progress may also necessitate cesarean birth. Less common are the anatomic or congenital conditions of mother or fetus that make vaginal birth undesirable. An estimated 2.5% of all births in the United States are cesarean birth on maternal request.
Contraindications
Like most surgical procedures, the gross instability of the mother (eg, hypovolemia, hypotension, sepsis) and uncertainty about fetal status are relative contraindications. That said, there are rare instances in which cesarean delivery must be performed to save a fetus when the mother is dying.
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