**2. Origin of word caesarean section and additional background of caesarean section**

Caesarean section has been recorded in history since ancient times in both Western and non-Western literature. Although the first use of the term in obstetrics was from the seventeenth century, its early history is obscured by mythology [6]. Many historians believe that the origin of the term caesarean section rather than caesarean is from the birth of Gaius Julius Caesar [3]. This belief has been challenged by many.

To start with, Gaius Julius Caesar certainly was not the first person born via caesarean section. The procedure, or something close to it, is mentioned in the history and legend of various civilizations from Europe to the Far East well before his birth. He was not even the first Roman born that way. By the time Gaius Julius Caesar entered the world, Romans were already performing caesarean sections, and the Roman law reserved the operation for women who died in childbirth (so that the woman and her baby could be buried separately) and as a last resort for living mothers in order to save the baby's life during deliveries with complications. In ancient times, it was performed only when the woman was dead or dying as an attempt to rescue the foetus. This annuls further the origin of the term from Gaius Julius Caesar because his mother Aurelia Cotta is known to have lived long enough to see her son reach adulthood and serve him as a political advisor. Some sources even suggest she outlived him and he had two sisters, one of whom at least was younger than him [2].

Another possible source for the term is the Latin verb *caedare*, meaning to cut, or the term for the children who were born by postmortem caesarean sections, who were called *caesones*. The Roman law, Lex Regis, which dates from 600 BC, required that infants be delivered abdominally after maternal death to facilitate separate burial. This has also been proposed as the origin of the term. The specific law in question was called the Lex Cesare [7].

Historical records claim that the earliest authenticated report of a child who survived caesarean birth is a document describing the birth of Gorgias in Sicily in approximately 508 BC [7]. During this time period, the caesarean operation remained crude at best. The abdominal incision was made lateral to the rectus muscles, and the uterus was incised at whichever portion was accessible through the laparotomy incision. The uterine musculature was not reapproximated, and the patient had to be physically restrained during the procedure because of unavailability of anaesthesia [2]. As operative techniques improved, caesarean section became safer and could be used at an earlier stage in difficult labours. Further modifications emerged including emptying the bladder and rectum preoperatively with catheters and enemas, respectively, to decrease the volume of these organs in the operative field, thereby reducing the risk of injury during the surgical procedure [2].

#### **3. Indications for caesarean section**

Caesarean delivery is performed when the clinician and patient feel that abdominal delivery is likely to provide a better maternal and/or foetal outcome than vaginal delivery. Indications for caesarean delivery vary depending on the clinical

**87**

*Caesarean Section in Low-, Middle- and High-Income Countries*

situation, resources available for patient care, and individual physician management techniques. There are no definitive algorithms available to the practicing obstetrician to direct when an abdominal delivery will benefit the mother and/or the foetus in every clinical situation. The decision to perform an abdominal delivery therefore remains a joint judgement between the physician and patient after carefully weighing the pros and cons of a caesarean delivery versus continued labour and/or operative or spontaneous vaginal delivery [3]. Some authors have suggested that the term "elective caesarean delivery" should probably be eliminated because a caesarean delivery is either "medically/obstetrically indicated" or "on maternal

The decision to perform an indicated caesarean delivery may be made antepartum (scheduled caesarean delivery) or as a result of concerns identified after labour has begun ("unscheduled caesarean delivery" or "unplanned caesarean delivery"). The terms "scheduled caesarean delivery" and "planned caesarean delivery" are used when the decision to perform a caesarean delivery does not occur as a consequence of a complication of labour but is planned antepartum such as in the case of repeat caesarean delivery, foetal malpresentation or placenta praevia. This therefore means that indications for caesarean delivery can be divided into indications that are of benefit to the mother (maternal indications), the foetus (foetal indications) or both (circumstances in which both foetal and maternal indications exist).

The indications can be further divided into absolute and relative indication in each of the maternal and foetal categories. Indications for caesarean delivery for maternal benefit include any situation in which it is inadvisable to continue to strive for a vaginal delivery out of concern for maternal outcome. In these situations, the woman undergoes a major abdominal operation for indications that are likely to decrease her risk for morbidity and/or mortality. In contrast, when a caesarean section is performed for foetal indications, the mother is undergoing major abdominal surgery when there is no immediate benefit to her but there is potential benefit to the neonate. In these situations, foetal health would be compromised if further

1.Previous hysterotomy (usually related to caesarean delivery, but also related to myomectomy or other uterine surgery). In the case of prior caesarean delivery, two prior caesarean deliveries are an absolute indication. However, women with one prior caesarean delivery can be offered trial of labour if there is no

2.Obstructive lesions in the lower genital tract including malignancies, condyloma acuminata, severely displaced pelvic fracture and leiomyomas of the lower uterine segment that interfere with the engagement of the foetal head.

3.Maternal infection (e.g. herpes simplex virus or human immunodeficiency

*DOI: http://dx.doi.org/10.5772/intechopen.88573*

request" and never truly "elective" [8].

efforts toward vaginal delivery were pursued [3].

additional risk to vaginal delivery [1, 3, 8, 9].

**3.1 Maternal indications**

virus (HIV)).

4.Prior classical hysterotomy.

5.Unknown uterine scar type.

6.Uterine incision dehiscence.

7.Prior full thickness myomectomy.

#### *Caesarean Section in Low-, Middle- and High-Income Countries DOI: http://dx.doi.org/10.5772/intechopen.88573*

*Recent Advances in Cesarean Delivery*

**caesarean section**

question was called the Lex Cesare [7].

**3. Indications for caesarean section**

lenged by many.

and laparotomy for the abdominal pregnancy. However, laparotomy alone would suffice. Confusion also arises among medical students when a foetus before the age of viability has to be delivered through abdominal surgery. Most obstetricians and gynaecologists refer to this procedure as hysterotomy rather than caesarean section.

**2. Origin of word caesarean section and additional background of** 

Caesarean section has been recorded in history since ancient times in both Western and non-Western literature. Although the first use of the term in obstetrics was from the seventeenth century, its early history is obscured by mythology [6]. Many historians believe that the origin of the term caesarean section rather than caesarean is from the birth of Gaius Julius Caesar [3]. This belief has been chal-

To start with, Gaius Julius Caesar certainly was not the first person born via caesarean section. The procedure, or something close to it, is mentioned in the history and legend of various civilizations from Europe to the Far East well before his birth. He was not even the first Roman born that way. By the time Gaius Julius Caesar entered the world, Romans were already performing caesarean sections, and the Roman law reserved the operation for women who died in childbirth (so that the woman and her baby could be buried separately) and as a last resort for living mothers in order to save the baby's life during deliveries with complications. In ancient times, it was performed only when the woman was dead or dying as an attempt to rescue the foetus. This annuls further the origin of the term from Gaius Julius Caesar because his mother Aurelia Cotta is known to have lived long enough to see her son reach adulthood and serve him as a political advisor. Some sources even suggest she outlived him and he had two sisters, one of whom at least was younger than him [2]. Another possible source for the term is the Latin verb *caedare*, meaning to cut, or the term for the children who were born by postmortem caesarean sections, who were called *caesones*. The Roman law, Lex Regis, which dates from 600 BC, required that infants be delivered abdominally after maternal death to facilitate separate burial. This has also been proposed as the origin of the term. The specific law in

Historical records claim that the earliest authenticated report of a child who survived caesarean birth is a document describing the birth of Gorgias in Sicily in approximately 508 BC [7]. During this time period, the caesarean operation remained crude at best. The abdominal incision was made lateral to the rectus muscles, and the uterus was incised at whichever portion was accessible through the laparotomy incision. The uterine musculature was not reapproximated, and the patient had to be physically restrained during the procedure because of unavailability of anaesthesia [2]. As operative techniques improved, caesarean section became safer and could be used at an earlier stage in difficult labours. Further modifications emerged including emptying the bladder and rectum preoperatively with catheters and enemas, respectively, to decrease the volume of these organs in the operative field, thereby reducing the risk of injury during the surgical procedure [2].

Caesarean delivery is performed when the clinician and patient feel that abdominal delivery is likely to provide a better maternal and/or foetal outcome than vaginal delivery. Indications for caesarean delivery vary depending on the clinical

**86**

situation, resources available for patient care, and individual physician management techniques. There are no definitive algorithms available to the practicing obstetrician to direct when an abdominal delivery will benefit the mother and/or the foetus in every clinical situation. The decision to perform an abdominal delivery therefore remains a joint judgement between the physician and patient after carefully weighing the pros and cons of a caesarean delivery versus continued labour and/or operative or spontaneous vaginal delivery [3]. Some authors have suggested that the term "elective caesarean delivery" should probably be eliminated because a caesarean delivery is either "medically/obstetrically indicated" or "on maternal request" and never truly "elective" [8].

The decision to perform an indicated caesarean delivery may be made antepartum (scheduled caesarean delivery) or as a result of concerns identified after labour has begun ("unscheduled caesarean delivery" or "unplanned caesarean delivery"). The terms "scheduled caesarean delivery" and "planned caesarean delivery" are used when the decision to perform a caesarean delivery does not occur as a consequence of a complication of labour but is planned antepartum such as in the case of repeat caesarean delivery, foetal malpresentation or placenta praevia. This therefore means that indications for caesarean delivery can be divided into indications that are of benefit to the mother (maternal indications), the foetus (foetal indications) or both (circumstances in which both foetal and maternal indications exist).

The indications can be further divided into absolute and relative indication in each of the maternal and foetal categories. Indications for caesarean delivery for maternal benefit include any situation in which it is inadvisable to continue to strive for a vaginal delivery out of concern for maternal outcome. In these situations, the woman undergoes a major abdominal operation for indications that are likely to decrease her risk for morbidity and/or mortality. In contrast, when a caesarean section is performed for foetal indications, the mother is undergoing major abdominal surgery when there is no immediate benefit to her but there is potential benefit to the neonate. In these situations, foetal health would be compromised if further efforts toward vaginal delivery were pursued [3].
