This procedure is often employed as an alternative to traditional, vaginal delivery when that might pose a risk to the mother or baby. Possible reasons given for Caesarean delivery include a prolonged labour (failure to progress), apparent fetal distress, multiple births, and breech presentation. The incidence of Caesarean sections increases among women who have received fertility drugs which often cause the mother to carry several offspring simultaneously.
Increased need for Caesarean section may be caused by higher maternal age, use of epidural analgesia for pain relief, a large fetus, maternal obesity, previous Caesarean, pre-eclampsia and eclampsia. Concerns have been raised in recent years, that the procedure is frequently being used in the U.S. for reasons other than medical necessity. Caesarean sections, when reviewed according to the principles of evidence based medicine, often appear to be ordered for non-medical reasons. Organizations have been formed to make the public aware of Caesarean operations and their dramatically increased incidence. Many common iatrogenic causes of slowed or ineffective labor can occur only in a hospital setting. Attendance by a midwife and out-of-hospital labor are associated with much lower rates of Caesarean section, when controlled for all relevant maternal and fetal indicators.
Vaginal birth after Caesareans ("VBAC") are now quite common. In the past, Caesarean sections used a vertical incision cutting the uterine muscle fibers. Current Caesareans typically use a hortizontal incision cutting along the muscle fibers. The uterus maintains its integerity and can tolerate the strong contractions of childbirth. Cosmetically the scar for modern Caesareans is below the bikini line and is sometimes called the "bikini cut".
Caesarean sections are so-named because, according to folklore, this is the method by which the Roman dictator Julius Caesar was delivered. However there is evidence that his mother was still alive when he was an adult, and given that at the time the procedure would have almost certainly resulted in the death of the mother, it is more likely that it is so named because it first came into use in the time of Caesar. The first recorded incidence of a woman surviving a Caesarean section dates from Germany in 1500: Jacob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labor.
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