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39. Caesarean section

By Dr J Kabyemela, MD

Caesarean section as a method of delivery has come a long way, even when viewed from as recently as the 1950s.

It can now be declared in absolute terms that caesarean section is a very safe procedure that should be carried out without hesitation in the presence of a valid indication. But this is where debate rages. Has caesarean section achieved a level of safety where it can be offered on demand? This question is not the mainstay of this chapter. In here, we have attempted to present broad and specific details about this everyday  surgical procedure.

It is extremely important to remember that, whatever degree of technical refinement achieved in performing it, caesarean section is and will remain a major surgical procedure. Any arguments for a more liberal approach towards caesarean section should never lose sight of this fact. On the other hand, those mothers who feel that they are well informed and would like to deliver by caesarean section regardless deserve the right of a sympathetic ear, though not necessarily an affirmative nod.

Between 10 and 30 per cent of all pregnancies are delivered by caesarean section. In the UK, the average was 15.5% in the mid-1990s and now stands at just over 24% (2006/07). In some parts of the USA and South America, the rate has been consistently above 25 per cent since the early 1990s and, like elsewhere continue to rise. In 2004, the rate in the US came in at just shy of 30%. In 2007, the figure was 31.8%. The rise is remorseless.

While childbirth in developed countries is now a very safe undertaking, as far as the mother is concerned, caesarean section is a riskier delivery method in terms of both death and illness.

Although the figures are very small (a death rate of less than 0.1 per cent), vaginal delivery remains a far safer way of having a baby today. In twenty or thirty years' time, quite plausibly, this statement may belong to history.

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