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Contents 1 Maimonides 2 More Trivia 3 600 BC 4 Dates 5 Questions 6 Julius Caesar 7 Popularity 8 "Caesarean" section 9 Risk 10 References 11 Herpes indicating a c-section 12 Multiple Births 13 "Movement to perform caesaren delivery on maternal request" 14 Lex Caesarea 15 Improving technique 16 Cochrane Claim 17 Etymology in Japanese and Korean 18 Ordering of sections 19 Lack of citations in the history section? 20 Method 20.1 Edit of history section. 20.2 source 21 Edit of VBAC section 21.1 Globalization tag 22 video talks about cesarian and jesus

[edit] Maimonides

"It should be noted that Maimonides, the famous rabbi, philosopher, and doctor, says that it was known in ancient Rome how to perform a c-section without killing the mother, but that the medical knowledge of his day was lacking and it was not performed."

This seems to contradict what Maimonides writes on his commentary on the Mishna in Bekhorot where he apparantly states that mothers would not survive this procedure at the time of the Tannaim. I have therefor added the {{Fact}} tag for this statement. 91.104.181.215 (talk) 02:12, 1 April 2008 (UTC)

[edit] More Trivia

I just noticed that this "In the video game Metal Gear Solid 3: Snake Eater, a main character called 'The Boss' exposes a c-section scar to Naked Snake (The player's character). The scar is possibly from a blundered procedure and runs from the abdomen to the breasts, and is in the shape of a snake." was included in an already useless section (no pun intended) of this article. The alarming incidence of Trivia found in these encyclopedia articles is beginning to concern me. I vote to remove if not the whole section, then at least the pointless reference to a video game. It is something I would have added back when I was 12. Would you appreciate me making a comment about how Sailor Moon or some cartoon character or even my aunt had a C Section? Thanks, and appreciate any comments. 22:27, 20 February 2008 (UTC) Is very much compelled at this point to register an account :P.

[edit] 600 BC

Wasn't Susruta performing, or promoting, caesarean sections in India in 600 BC? Carl Kenner 17:41, 16 May 2006 (UTC)

[edit] Dates

It would be nice to see a date on the statistics here.

[edit] Questions

Can I ask a question? I have a few questions on c-section delivery?

Please address them to the Reference Desk. It is not possible to respond to practical questions here if they have no direct bearing on the article content. JFW | T@lk 14:40, 19 Dec 2004 (UTC)

[edit] Julius Caesar

"The caesarean is possibly named after the Roman dictator Julius Caesar who allegedly was so delivered. Historically, this is impossible as his mother was alive after he reached adulthood, but the legend is at least as old as the 2nd century AD." How does his mother being alive make it impossible? Jamesmusik 02:39, 11 July 2005 (UTC)

Especially considering that the article later discusses an African tribe which, at least in the 19th century, performed them routinely and seemingly with some success in keep the mother alive. Wahern 01:06, 10 May 2006 (UTC)

Well, if you see how it is performed from a physicians' point of view, you will understand.Even with today's high-tech surgical techniques and equipment, a c-section is accompanied by massive blood loss (which of course can be corrected easily), risk for fetal hypoxia and respiratory failure (which can also be treated) ,risk for maternal anemia and a lot more.Nowadays these complications can be predicted and treated in the vast majority of cases (low mortality) , so the risk both for the mother and the fetus is low.

 During Caesar's time , it would be almost impossible for a mother to survive such surgery ,not to

mention the fetus.In my personal opinion this operation would have a maximum success rate of 1-5% during that time ,which is not fit for a king :)--NatK 23:01, 17 May 2006 (UTC)

The etymology and history sections are inconsistent, as the former says Caesar was unlikely to have been delivered this way, given his mother's survival (her longevity seems irrelevant), the latter that he wasn't. As a matter of evidence, nobody knows either way, so it should just be assessed as unlikely.--80.6.163.58 20:44, 24 November 2006 (UTC)

[edit] Popularity

It would be nice to see some mention of the increasing popularity of the procedure. I am not competent enough to describe the phenomenon but I am noticing more women are undergoing it...some mention of the nasty scarring would be nice too. Jeffrey King (talk · contribs).

Jeff, I completely agree. JFW | T@lk 14:53, 19 September 2005 (UTC)

We really need to mention elective caesareans. violet/riga (t) 22:44, 2 November 2005 (UTC)

[edit] "Caesarean" section

[edit] Risk

Unless you understand what your talking about you're better saying nothing.

[edit] References

I spotted one spot that very clearly needs a reference, I put a tag in. There's a few other authors and dates given in the text, but nothing in the references section at the end about them. --zandperl 02:45, 1 March 2006 (UTC)

The cave painting picture is obviously faked. Why is it here? Is there any other evidence that c-sections were performed in ancient Madagascar, or should that whole passage come out? Vynce (talk) 03:26, 6 February 2008 (UTC)

Yes, clearly fake as the image page even links to the original untouched photo. Removed Ciotog (talk) 03:51, 6 February 2008 (UTC)

[edit] Herpes indicating a c-section

• here. "Since most neonatal infections are acquired from contact with infected maternal genital tract secretions, potential preventative strategies include: Caesarean delivery, serologic screening of pregnant women, prophylactic acyclovir and vaccination. The two strategies currently accepted by most obstetricians are Caesarean delivery for women with active lesions or prodromal symptoms and prophylactic acyclovir for women with gestational herpes." Nandesuka 03:37, 6 May 2006 (UTC)

[edit] Multiple Births

Can anyone expand on why a c-section for multiple births is controversial? Either an explanation or a reference would be good imo. Chovain 07:38, 31 May 2006 (UTC)

When the "Twin Trial" finishes you will have an answer.

I'd guess each baby is smaller than in the average single birth, so vaginal delivery should be easier?--Shtove 20:51, 24 November 2006 (UTC)

[edit] "Movement to perform caesaren delivery on maternal request"

http://en.wikipedia.org/w/index.php?title=Caesarean_section&curid=46924&diff=57399554&oldid=57297042

With increased safety in performing a caesarean section, there has been a movement to perform [[caesaren delivery on maternal request]].

I'm reverting this change, as it's uncited, and "An independent panel of experts assembled by NIH has determined that there is not enough quality evidence to fully evaluate the risks and benefits of caesarean delivery on maternal request (CDMR) as compared with planned vaginal delivery. More research, they said, is needed." [1]. If anyone can find a reference supporting the claim, then it should go back in, but probably also with the NIH reference for NPOV. Chovain 06:52, 8 June 2006 (UTC)

Well, I am putting the sentence back because it serves as the link to new page on caesarean delivery on maternal request where the issue is discussed and referenced. Ekem 13:57, 8 June 2006 (UTC)

Woops, sorry about that. I can't believe I didn't even follow the link :-/. Chovain 23:57, 8 June 2006 (UTC)

[edit] Lex Caesarea

Roman laws were commonly named after their enacting legislator. However, the lex Caesarea originates from a law created by Rome's 2nd king, Numa Pompilius, whereby a woman who died pregnant could not be buried until her child had been delivered. It's not clear when the law was enacted but the reign of Numa Pompilius ended with his death in 673BC.

Since the Lex Caesarea, requiring all women who died in labour to have a post-mortem delivery, was introduced in the 8th century BC, then the operation cannot originally have been named for the manner of Julius Caesar's birth many centuries later - whether or not by caesarean section. However, perhaps our spelling of the law's name may have changed. It seems very likely that the original law was named from the verb caedo, to cut, as it is recorded that the phrase a matre caesus (cut out of his mother) was used in Roman times to describe this operation. The difficulty is that the word caesareus cannot be derived simply from caesus - and therefore may relate in some way to the word Caesar. Is there definitive evidence of what the ancient Roman law was called in, say, the 4th and 5th centuries BC? Did it change after Julius Caesar's reign - perhaps because writers like Pliny the Elder, after Caesar's death, linked his name (though not the manner of JC's birth) to the operation?

Remember that we are dealing with a folk etymology. "Lex Caesarea" here probably means no more than "imperial law", i.e. Roman law generally, and this description, if ever used at all, would have been many centuries after the event. If there was really a law dating from Numa Pompilius, it would not be called after the introducer, as this practice originated in the Republic.

Pliny's story was about a remote ancestor of Julius Caesar. A later urban myth made it relate to Julius Caesar himself. I am positive that the operation got its name from the story recorded in Pliny (whether Pliny was the source or he was recording an older tradition). All the stuff about "Lex Caesarea" and about caedo is later rationalization with no historical basis. --Sir Myles na Gopaleen (the da) (talk) 12:02, 10 June 2008 (UTC)

[edit] Improving technique

Did surgical techniques prior to the 19thC gradually improve the survivability of the operation, or was it only the listed stuff (uterus suturing etc) that made the difference? In other words, was a mother more likely to survive the operation in the 16/17/18thCC than her Roman counterpart?--Shtove 20:49, 24 November 2006 (UTC)

[edit] Cochrane Claim

I removed the following: However the Cochrane review of midwife continuity of care (Hodnett 2006)found no difference in the rate of caesarean delivery in midwife care on conventional medical led care.

I searched cochrane.org and was unable to find any citation of the Hodnett study that found this. There were ten articles by Hodnett indicating that there were better outcomes from midwifery care, but not the claim cited above. Could the editor please provide a better citation for the claim please. Maustrauser 00:15, 21 December 2006 (UTC)

I agree. The citation needs to point to the actual study, or be left out. Watch out for WP:3RR though. I'll revert if it comes up again in the next few hours. Chovain 02:06, 21 December 2006 (UTC)

I've reverted the change, and placed a 3rr warning on the user's talk page. Chovain 03:22, 21 December 2006 (UTC)

I placed the Cochrane reference and note the above comments. I am a first time user and am familiarisinf myself with the rules. I am still not sure how to properly reference articles quoted. If it helps the full station is "Hodnett ED Continuity of caregivers for care during pregnancy and childbirth. Cochrane Database of Systematic Reviews 2000, Issue 1. Art. No.: CD000062. DOI: 10.1002/14651858.CD000062. I am sorry for not following your rules but do believe this is the highest level evidence available on the matter of caesarean rates and model of care —The preceding unsigned comment was added by Andrusha29 (talk • contribs) 03:28, 21 December 2006 (UTC)

Thank you for your reference. It gave me enough information to properly find it. The results made NO finding about caesarean sections so I'm not sure how you managed to write what you did. These are the findings verbatim: Two studies involving 1815 women were included. Both trials compared continuity of care by midwives with non-continuity of care by a combination of physicians and midwives. The trials were of good quality. Compared to usual care, women who had continuity of care from a team of midwives were less likely to be admitted to hospital antenatally (odds ratio 0.79, 95% confidence interval 0.64 to 0.97) and more likely to attend antenatal education programs (odds ratio 0.58, 95% confidence interval 0.41 to 0.81). They were also less likely to have drugs for pain relief during labour (odds ratio 0.53, 95% confidence interval 0.44 to 0.64) and their newborns were less likely to require resuscitation (odds ratio 0.66, 95% confidence interval 0.52 to 0.83). No differences were detected in Apgar scores, low birthweight and stillbirths or neonatal deaths. While they were less likely to have an episiotomy (odds ratio 0.75, 95% confidence interval 0.60 to 0.94), women receiving continuity of care were more likely to have either a vaginal or perineal tear (odds ratio 1.28, 95% confidence interval 1.05, 1.56). They were more likely to be pleased with their antenatal, intrapartum and postnatal care. See: http://www.cochrane.org/reviews/en/ab000062.html Maustrauser 04:03, 21 December 2006 (UTC)

If you read the article rather than the abstract which makes no comment re caesarean rates (as it only mentions findings which were significantly different between the two groups) you will find there was no difference in Caesarean delivery rates (odds ratio 0.94, 95% CI 0.69-1.28)It is on page 16 of the pdf version. —The preceding unsigned comment was added by Andrusha29 (talk • contribs) 04:36, 21 December 2006 (UTC)

I'd be more than happy to write the citation for this, but it won't be until I get home in about 2 or 3 hours (where I'll apparently have free access to the library). Is everyone happy to wait?

Btw, Andrusha: The best way to sign your posts is to place 4 tildes (~~~~), instead of typing it out.

Chovain 05:29, 21 December 2006 (UTC)

Thank you, I am gradually get Wik literate Andrusha29 10:14, 21 December 2006 (UTC)

No problem, but the sig normally goes at the end of your comment ;). We all had to learn at some point. I've updated the relevant paragraph, and included a proper citation. Nice reference by the way! I'd now like to see the previous sentence's citation fixed up. I don't have a medical background: Is there any way you could help with finding which paper "Gaskin 2003" is refering to? Cheers, Chovain 10:39, 21 December 2006 (UTC)

Gaskin is Ina May Gaskin and referes to her book Ina May's Guide to Childbirth, Batam Books, 2003 Maustrauser 11:19, 21 December 2006 (UTC)

I can't say I am particularly impressed with the Hodnett study which was undertaken in 2000 and used data from two studies done in 1989 and 1995 using a sample size of 907. A more recent citation which showed a significant difference between standard care and midwifery care with regard to caesareans was published in BJOG British journal of obstetrics and gynaecology,2001, vol. 108, no1, pp. 16-22. Its findings are:

Objective To test whether a new community-based model of continuity of care provided by midwives and obstetricians improved maternal clinical outcomes, in particular a reduced caesarean section rate. Design Randomised controlled trial. Setting A public teaching hospital in metropolitan Sydney, Australia. Sample 1089 women randomised to either the community-based model (n = 550) or standard hospital-based care (n = 539) prior to their first antenatal booking visit at an Australian metropolitan public hospital. Main outcome measures Data were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. Results There was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the community-based group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR = 0.6, 95% CI 0.4-0.9, P = 0.02). There were no other significant differences in the events during labour and birth. Eighty babies (14.5%) from the community-based group and 102 (18.9%) from the control group were admitted to the special care nursery, but this difference was not significant (OR 0.75, 95% CI 0.5-1.1, P = 0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1000 births. Conclusion Community-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.

Unlike the Hodnett study, this study was set up SPECIFICALLY to test whether continuity of care was better than standard care with regard to caesarean sections. Thus I think this study should be cited rather than the older and statistically less relevant Hodnett study. Maustrauser 11:01, 21 December 2006 (UTC)

But that study compared continuity of care by obstetricians and midwives with hospital based care random staff, not midwifery care with medical led care, so it is not relevant in terms of comparitive caesarean rates between midwife care and medical care. By the way the reference for the comment you are looking for is probably a book "Ina May's Guide to Childbirth, Ina May Gaskin, Bantam Dell, A Division of Random House, Inc., New York, 2003" but I haven't read it to check whether this is certain.Andrusha29 11:14, 21 December 2006 (UTC)

Steady on, Maustrauser. The Cochrane review I cited covers 1815 women randomised to continuity of care by a midwife, or conventional medical care where women see different midwives/obstetricians each visit. The fact that there is no difference in caesarean rates between these two groups is far more telling than a study comparing continuity of care by obstetricians and midwives with non continuous care by obstetricians and midwives. IE your article verifies that continuity of care achieved a lower CS rate than non continuity of care. The Cochrane review showed that care with midwives did not result in a lower CS rate compared to conventional care. I would ask that the Hodnett reference be reinsatedAndrusha29 11:25, 21 December 2006 (UTC)

---

I've reinstated the Hadnett reference. I see no compelling reason why either one should not be listed. The article now reads as though the articles are conflicting.

The wording of each study's findings sounds like it will need improvement. I'd like to suggest that the wording be discussed here on the talk page rather than in endless edits to the article. Cheers, Chovain 18:32, 21 December 2006 (UTC).

Fair enough. The 2001 study cited by Maustrauser is a good study, prospective and randomised. But it is not testing the hypothesis that midwifery care may lead to a different rate of caesarean rate to medical care. The comparison was between continuity of care (by midwives and/or obstetricians)and no continuity of care. Wikipedia document in question is not one which seeks to show midwifery care is better or worse that medical care, it is an article on caesarean section. My reference to the Cochrane review was made because the Cochrane review only includes studies with high level evidence and is considered the most authoritative evidence base to guide decisions regarding medical care. May I suggest that the apparent conflict be addressed by the following statement. Studies have shown that continuity of care with a known carer may significantly decrease the rate of caesarean delivery (Maustrauser's ref) but that there is no high level evidence of any difference in caesarean rates when comparing midwifery care to conventional medical led care. (Cochrane reference)Andrusha29 20:30, 21 December 2006 (UTC)

Thank you Chovain for the moderation. I too am happy to discuss changes here. Firstly may I apologise for my claim about sample size. I didn't add the control and non-control groups together!

With regard to the two studies, the Hodnett study is a meta-analysis whilst the Homer study set out specifically to test whether continuity of care gave a better result than medical care (I think better termed 'fragmented care'). Neither study tested 'pure' midwifery care versus 'medical care'. The two studies (Rowley and Flint) quoted by Hodnett whilst described as 'midwifery care' also used obstetricians (as you would expect from an ethical study!) Thus I think we can say that all three studies (Rowley, Flint and Homer) all looked at the same thing - continuity of care versus fragmented care.

Hodnett found no difference in caesarean rates. Homer found statistically significant differences in rates. The Hodnett study is older and was not specifically designed to test caesarean rates, and therefore I believe it is inferior to the Homer study. Therefore I cannot agree to the words 'high level evidence' - I don't think the Rowley or Flint trials were any better than the Homer study and given that they were not designed to test caesarean rate outcomes, they shouldn't be quoted as supporting the view that both continuity of care and fragmented care gives the same caesarean outcomes.

I propose the following wording. "Studies have shown that continuity of care with a known carer may significantly decrease the rate of caesarean delivery (Maustrauser's ref) but that there is also some older research that appears to show that there is no significant difference in caesarean rates when comparing continuity of care to conventional medical-led care. (Cochrane reference).

Finally, I think we need to check out the Gaskin reference properly. Clearly this argument all started because Andrusha29 wished to provide a balancing remark to the Gaskin reference. I think we need to find out whether Gaskin was talking about continuity of care with a known carer (including obstetricians) or pure midwifery care (which I doubt). If it is the first, then I'd bet that Gaskin is quoting Homer's study! Maustrauser 23:07, 21 December 2006 (UTC)

Excellent progress. I don't have any difficulty with your suggested compromise, although if you read the Hodnett paper, you will see that"Both trials compared continuity of care by midwives with routine care by multiple physician and midwife caregivers". So it truly is a comparison between midwife continuity care with routine "fragmented care" (a description which I believe is very appropriate).

As far as the Gaskin quote, I don't think it is based on any study, but is a short summary of the author's opinion expressed in her book. If based on any published work, it would be on results in pregnancies where women have selected midwife care compared to standard care, which would be expected to skew results. I have not, however, read the book, so this is my guess only. Academically speaking, I think the Gaskin quote represents a much lower level of evidence (Level 3/4) than the cochrane data (Level 1)and would prefer that the Gaskin quote be presented as opinion rather than evidence.Andrusha29 23:49, 21 December 2006 (UTC)

Don't you ever sleep Andrusha29? Splendid, I think we nearly have agreement then. My comments about Hodnett and the Rowley and Flint studies comes from pages 5&6 where under interventions it lists the obstetric care the women in the trial group received. Flint women received midwifery care + 2 visits to obstetricians and then as needed. Rowley women received midwifery care + 3 visits to obstetricians and additional visits as needed. Thus both Flint and Rowley studies used 'shared care' (continuity) as the model they were testing versus 'standard' fragmented care.

Whilst I'm not so sure that Gaskin is using anecdotal evidence (she has a good reputation as a rigorous midwife) I agree that her comments are of a lower order of evidence. Perhaps we should remove her quote as it is clear from the three studies we have above, that we have 'primary' evidence. Any view on this Chovain? Maustrauser 00:03, 22 December 2006 (UTC)

Ok, how does this wording sound (bringing in Andrusha's terminology near the end)?

Studies have shown that continuity of care with a known carer may significantly decrease the rate of caesarean delivery^[10] but that there is also some older research that appears to show that there is no significant difference in caesarean rates when comparing midwife continuity care to conventional fragmented.^[11]

Chovain 00:07, 22 December 2006 (UTC)

I think that is a good evidence based summary and would support it, as well as removing the Gaskin citation which I agree is superceded by the direct evidence citationsAndrusha29 01:18, 22 December 2006 (UTC)

Excellent. I'll do it. Maustrauser 01:29, 22 December 2006 (UTC)

I've removed Gaskin but I'm having trouble with the references. Could I ask you to do it please Chovain? The only thing your revised quote needs is to add the word 'care' after fragmented. Thanks for your help Maustrauser 01:32, 22 December 2006 (UTC)

All done. Thanks a lot guys - it's been a pleasure working with you both. Chovain 02:42, 22 December 2006 (UTC)

Ditto. It shows how debating ideas (rather than debating people) can lead to a good result. And thanks for your timely and helpful interventions Chovain! Maustrauser 03:50, 22 December 2006 (UTC)

No problem - I'm glad I was able to help even though the details were over my head. Chovain 05:02, 22 December 2006 (UTC)

Yes I must say I am impressed with the way this wikipedia concept works. As I said before I am a first time user. Do you guys do this all the time?Andrusha29 04:44, 22 December 2006 (UTC)

I do thas a little too much of the time, I suspect :). Chovain 05:02, 22 December 2006 (UTC)

[edit] Etymology in Japanese and Korean

The ja-Wikipedia states that 帝王切開 is a direct translation of Kaiserschnitt, which is highly likely, as the Japanese imported gobs of German medical terminology during the Meiji era, and then exported it onward to their colony (at the time), Korea. No reference given though, alas. Jpatokal 09:14, 28 May 2007 (UTC)

[edit] Ordering of sections

Why is the etymology and history stuff placed ahead of the medical information? If nobody objects, I'd like to move these sections down to just before "Caesareans in fiction". Eleland 22:09, 14 July 2007 (UTC)

[edit] Lack of citations in the history section?

I am not thoroughly knowledgeable about Wikipedia's rules on sourcing information, but a number of the facts or claims in the history section strike me as being worthy of having a source to back them up. Or is the history of the C-section (first European C-section with survival of mother, routine practice in northern Africa, etc.) considered common knowledge that requires no citation? 212.99.207.5 16:15, 7 August 2007 (UTC)

These should all have references. Any help would be greatly appreciated. Mark Chovain 20:58, 7 August 2007 (UTC)

[edit] Method

An OB told me that the modern lower uterine incision method no longer requires muscles to be cut. Is this correct? --216.19.177.73 19:05, 30 October 2007 (UTC)

[edit] Edit of history section.

Changed: Caesarian section sacrificed the mother for the sake of the child;

Into: Caesarian section usually resulted in the death of the mother;

As the alternative to performing the c-section wouldn't have been the survival of the mother (stilbirth wouldn't warrant a c-section) but the death of both mother and child thus making the c-section an attempt at salvaging life and not an act of sacrificing one over another. 85.24.87.244 03:34, 13 November 2007 (UTC)

[edit] source

BBC.co.uk: Caesareans 'may harm lung growth' I dorftrottel I talk I 14:16, December 12, 2007

[edit] Edit of VBAC section

I have added a short section to the end of this section to describe the issue of VBAC bans in the United States and the ACOG guideline change in 1999 that caused it. I have included citations with links to the official guideline, a medical study from the Annals of Family Medicine and a 2005 USA Today article that discusses the issue at some length. I believe that this addition is properly placed here in the Caesarean Section article because it relates both to VBACs and a reason why some women feel pressured into having repeat c-sections.Jeanne9000 (talk) 06:16, 9 February 2008 (UTC)

[edit] Globalization tag

I have removed the globalization tag because it is unexplained. If you think that it's deserved, then please explain your concerns in detail right here on the talk page. This will help other editors figure out how to address your concerns. Thanks, WhatamIdoing (talk) 20:18, 4 March 2008 (UTC)

[edit] video talks about cesarian and jesus

http://video.google.com/videoplay?docid=4675077383139148549 go to 1 hour 36 minutes. —Preceding unsigned comment added by 76.94.193.157 (talk) 04:25, 24 May 2008 (UTC)