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Pregnancy Bliss | Reproductive Health Hub


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Does the term ‘lower segment caesarean section’ refer to the common skin incision?

No. This is likely to be found on the consent form. If left unclarified, the woman may assume it refers to the skin incision. In fact, it refers to the incision on the womb. Its mention is not an act of mere pedantry on the part of the doctors, as it has a very important implication. We shall see why shortly.



How is the womb (uterus) opened?

The most common incision is the lower segment transverse incision. This is because it is an easier approach, bleeds less, is easier to repair and gives the strongest scar.

Historically, the incision used was a vertical upper segment one. It is in the historical context that this old method has come to be known as "classical caesarean section". This is used only in exceptional circumstances, such as extreme prematurity (where it may be easier and safer for the baby).

Another kind of approach is a lower vertical incision, also used in special circumstances only.

More than 90 per cent of all caesarean sections are performed through a lower segment transverse uterine incision.



Baby safety with caesarean section


One fact that every mother deciding on mode of delivery need to bear in mind is the safety of the baby. Caesarean section on maternal request (or demand) is increasingly common. It is, however, important to be aware that a caesarean section in the absence of a medical or obstetric indication could turn out to be a big and tragic mistake.


There is solid evidence that, in low risk pregnancies, babies born by caesarean section  are at higher risk of neonatal mortality compared to those delivered vaginally. A  study published in the medical journal Birth in March 2008  looking at all U.S. 'Term' Births (and neonatal deaths) between 1999 and 2002 revealed that the risk of neonatal death for the caesarean babies was more than twice that of those delivered vaginally.



Why a caesarean section


What are the indications for caesarean section?

There are many different indications, both maternal and fetal. Listed below are some of the more common maternal indications:


Maternal pelvis: if the birth canal is deemed too narrow to allow safe passage of the baby, a caesarean section will be the only option. This state of affairs may be recognized following previous experience such as labour that was very difficult or that never progressed beyond a certain point. In such a case the caesarean section will be planned electively. It may otherwise be discovered in the course of labour and caesarean section is resorted to.


Previous caesarean section: In the United States, less than 10% of women with previous caesarean section have a vaginal delivery. Figures in Europe and other parts of the world are a lot higher. Previous caesarean delivery is not always an indication for repeat caesarean section, except in a situation where the reasons for the previous caesarean section are still there, such as a narrow pelvis.


Medical conditions: Presence of serious medical conditions such as heart failure or serious respiratory conditions is sometimes deemed an indication for caesarean delivery in order to circumvent the stresses and strains of labour. More often, instrumental (vaginal) delivery in the form of forceps or ventouse is opted for.


Abnormal placental position: A low-lying placenta (a condition known as "placenta praevia") is an indication for caesarean delivery.


Placental abruption: If the placenta detaches partially or wholly during pregnancy or labour, emergency caesarean section may be performed, especially if there is hope of saving the baby.

Previous plastic or corrective surgery to the vagina: If childbirth risks undoing the previous surgery, then the only way of getting around this problem is to perform a caesarean section.

Failure to progress in labour: if labour appears to be getting nowhere in spite of everything, abdominal delivery may be the only option.

Morbid fear of labour: In late 2011, The National Institute of Clinical Excellence (NICE) in Britain published guidelines which, for the first time, explicitly recognised morbid fear of labour (tocophobia) as a legitimate indication for caesarean section. A woman can therefore request to have an elective (planned) caesarean section citing this as her reason for the request.


Fetal Indications for caesarean: Next Page