Cesarean section is a surgical procedure that consists in removing the newborn baby through the abdominal route after incision of the abdominal wall (laparotomy) and the uterus (hysterotomy). It is practiced when the low route is impossible or contraindicated. Cesarean section is performed by an obstetrician, in an operating theater, under anesthesia.

Cesarean section can be performed during labor in case of:

• failure to induce labor
• stagnation of cervical dilation
• non-engagement of the baby at full dilation
• fetal distress (indicated by abnormalities in the baby’s heartbeat on the monitor)
• poor presentation of the baby
• forceps failure
• cord procidence (passage of the umbilical cord into the vagina)
• maternal complication of an already existing pathology
• a baby that is too big (macrosomia) with an estimated birth weight of between 4500 g and 5000 g (on a case-by-case basis) and greater than 4500 g in the event of gestational diabetes
• suspected macrosomia with a history of shoulder dystocia
• stage III or IV placenta previa
• the presence of an obstacle to the exit of the child (ovarian cyst, fibroid)
• a breech presentation (on a case-by-case basis depending on the pelvimetry, the estimate of the baby’s weight and the presentation of his head)
• a twin pregnancy (on a case-by-case basis)
• history of 3 or more cesarean sections (a scarred uterus is not in itself an indication for a planned cesarean section)
• mother’s heart condition that does not allow her to support childbirth.

Cesarean section can be scheduled upstream if vaginal delivery is impossible or contraindicated, in these different situations (3):

Some scheduled cesarean sections are “convenient cesarean”, that is to say made at the request of the mother-to-be for different reasons (fear of childbirth, past trauma, desire to preserve her sexuality, etc.), but no medically justified. They must be discussed with the medical team, who will remind the parturient of the risks inherent in the cesarean section, which remains an “attack on the body”.

Cesarean section can be performed before labor, as an emergency, because the continuation of the pregnancy endangers the mother and / or her baby. This happens in case of:

• severe hypertension, preeclampsia, toxemia of pregnancy
• blood clotting disorder
• maternal hemorrhage following placenta praevia
• premature detachment of the normally inserted placenta (DPPNI)
• suspected uterine rupture

In France, around 30% of Caesarean sections are scheduled, 50% are Cesarean sections occurring during labor and the rest are performed before labor (4).

Depending on the degree of urgency of the situation, the anesthesia will be different:

• if the mother benefited during labor from an epidural, it will be reinforced with the injection into the catheter already in place of more concentrated doses of anesthetic. This is called “extension of the epidural”.
• if the mother did not benefit from the epidural or if the cesarean section is scheduled, a spinal anesthesia is performed. Unlike the epidural, the product of which is injected into the nerves of the spinal cord, the anesthetic product is injected directly into the fluid which envelops the spinal cord. Spinal anesthesia is therefore effective more quickly, which makes it possible to start the intervention more quickly (weighted average difference = 7,91 minutes less (5)).
• in rare cases, general anesthesia may be performed in cases of extreme emergency or a contraindication to locoregional anesthesia.

Where possible, loco-regional anesthesia will always be preferred as it is associated with lower maternal mortality, less medication needed, more direct experience of childbirth, faster development of the patient. link between mother and newborn, lower blood loss and excellent postoperative pain control with the use of central opiates (6).

 In France, 40% of cesarean sections are performed under epidural anesthesia, 60% under spinal anesthesia and less than 5% under general anesthesia (7). 

Concerning the origin of the word “caesarean”, historians evoke three hypotheses (8). The word could come:

• Latin hacked meaning “to cut”
• of the Roman text which legalized the operation, the the law court, renamed the law cacsarea after the advent of Caesar
• the birth of Julius Caesar by abdominal route. This hypothesis seems unlikely, however, because the mother of Julius Caesar survived his birth … but under the conditions in which the caesarean was performed at that time, death was the certain outcome for the mother.

Several elements suggest that the practice already existed during Antiquity, but it was during the Renaissance that the caesarean section as it is considered today – on a living woman with the goal of the survival of the mother and of her baby – appears. In a medical treatise dated 1581, the Treated ?? new from hystÌ rotomotoky or Caesarean birth, François Rousset describes step by step the progress of this operation. But at the time, the outcome was often fatal. It was not until 1850 that the “modern” cesarean was implemented. Since then, the technique has constantly improved to reach today a low maternal and fetal risk – but still higher than that of a vaginal birth.