ABSTRACT

In the past and, to a lesser degree, in the present, a caesarean section has been branded as a dangerous procedure and a commonly used excuse for hazarding the life and health of the fetus by not performing a caesarean section has been that to do so would unduly threaten the life of the mother. In the past, gross mortality rates have been relatively high; for example, in the late 1950s, the mortality rate for caesarean section was around one in 400. However, even then, the majority of women who died were already sick and debilitated before the operation or had a condition which, in itself, was life threatening, but could only be managed by caesarean section. The former group included women with severe pre-eclampsia; the latter included women with major degrees of placenta praevia. If the present mortality figures for caesarean section are analysed, it will be seen that the risk to the life of a healthy woman undergoing an elective caesarean section for a reason such as breech presentation or previous caesarean section is no greater than that for the average woman undergoing childbirth. Moreover, the risk to a healthy woman from a caesarean section is largely from infection and thromboembolism; these risks can be minimised by prophylactic administration of antibiotics and anti-coagulants. This is now mandatory practice. Providing prophylactic antibiotics and anti-coagulants are given, the risk to a woman from elective lower segment caesarean section is so low that many would consider the operation should be performed at the woman’s request.