Inconclusive conclusion

Sloan, Don

doi:10.1016/0002-9378(68)90499-7

American Journal of Obstetrics and Gynecology

1968

DOI: 10.1016/0002-9378(68)90499-7

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Inconclusive conclusion

Don Sloan

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1977

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Cited by 5 publications

(2 citation statements)

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“…She is faced with the prospect of a repeat cesarean in subsequent pregnancies, although this is a questionable matter at the present time. 3 And yet, we know that a cesarean is sometimes necessary, and must be done. What can be done to take advantage of the benefits of a needed cesarean, and yet minimize the damage?…”

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confidence: 99%

Having a Section is Having a Baby

Enkin

1977

Birth

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Cesarean section was not always having a baby. For that matter, it was not always having a mother, either. The operation has been done even before the time of the Romans, but got its name not from Julius Caesar, who was not born by cesarean section, but from the Latin caedere-"to cut." Gnaeus Pompeius decreed that the baby be removed from the mother by an abdominal incision after the mother had died, so that they could be buried separately.' The first recorded performance of a cesarean on a living woman took place in 1500, not by a doctor o r a midwife, but by a sow gelder named Jacob Nuffer, who knew nothing about midwifery. When his wife could not give birth, and the midwives and surgeons gave her up for lost, he did the obvious thing. She lived t o the age of 77, but we have n o record of what happened t o the baby.l From the beginning of the 17th Century, the operation was tried several times as a last resort, but the results were not always as good as Nuffer's. In 1784 Aitken wrote, after a good description of the technique, "This formidable operation, intended to save mother and child, has been performed during many centuries with various success. In Britain, it has never fully had the desired effect, all the mothers having died."* This may give a little background t o the concepts we have about this operation, and the fears engendered by the very name today. And yet recently, we have seen an incredible change in the attitude of obstetricians t o cesareans, to the extent that while as recently as 10 years ago, we obstetricians had the difficult job of explaining t o our peers why a cesarean was done, today we have the even more difficult job, often, of explaining why a cesarean was not done. Depending o n the hospital, from 10-1 5% or more of births are by cesarean today. Whether o r not this is justified is another concern. The fact is that today, not only is having a section having a baby, but often, having a baby is having a section.Technically, a cesarean birth is simple and safe. Modern anesthesia has improved to the point where anesthetic risks are virtually nil. The risks of hemorrhage have been reduced with improved surgical techniques and blood transfusion. The fears of infection have been counterbalanced by proper attention to asepsis, and to the antibiotics we have available. The classical operation, with its dangerous and weak incision into the upper segment of the uterus, has almost completely disappeared. It has been replaced with an incision into the lower uterine segment, which is strong and virtually without risk of rupturing in a subMurray W . Enkin is an Associate Professor of Obstetrics and Gynecology at McMaster .University Medical School, Hamilton, Ontario. He is a board member of we may properly ask "Why avoid a

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Having a Section is Having a Baby

Enkin

1977

Birth

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“…So deep seated was this bias that in 1968, when a group of obstetricians in New York City was asked, "Assuming you could be shown documentation and overwhelming evidence of the safety of permitting labor following cesarean section, would you allow this to alter the management of your patients? ", 80 percent answered no (2). In 1974,99 percent of patients in the United States with a prior cesarean section were delivered by repeat cesarean section (3), although in 1987 the percentage had decreased to only 90 percent (4).…”

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Vaginal Birth After Two or More Cesarean Sections: A Five‐Year Experience

Hansell

McMurray

Huey

1990

Birth

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Allowing a trial of labor in patients who have had a single low transverse cesarean section has become increasingly accepted and widespread in the United States. Evidence with regard to the safety of this practice in patients with two or more prior cesarean births has, however, been sparse. We performed a retrospective review of the charts of 170 patients who had undergone two or more low transverse cesarean deliveries and subsequently delivered at Wishard Memorial Hospital between January 1, 1983, and December 31, 1987. Of 35 of these women who underwent a trial of labor, 27 (77%) had a successful vaginal delivery. No increase in maternal or fetal morbidity or mortality was associated with labor. The women who underwent trial of labor had fewer postpartum complications and shorter hospital stays. Although the number of patients in this study was small, growing evidence appears to support a trial of labor in patients with two or more prior cesarean sections as a safe and successful alternative to elective repeat cesarean section.

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Vaginal delivery following previous cesarean birth

Martin

Harris

Huddleston

et al. 1983

American Journal of Obstetrics and Gynecology

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Inconclusive conclusion

Cited by 5 publications

References 11 publications

Having a Section is Having a Baby

Having a Section is Having a Baby

Vaginal Birth After Two or More Cesarean Sections: A Five‐Year Experience

Vaginal delivery following previous cesarean birth

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