CESAREO, TAGLIO. — This is the extraction of the fetus and adnexa through the uterine wall. The name seems to derive from the description that Pliny the Elder, in his Natural History, gave of the birth of Scipio Africanus: « a caeso matris utero ».
Certainly an ancient procedure, it was performed, almost until our own day, either on a dying woman as a last attempt to save the fetus, or when it was decided to sacrifice the mother’s life for the benefit of the fetus. This was because, given the primitive technique (the unsutured uterus was generally left in the abdominal cavity, thereby causing hemorrhage and infection) and the absence or inadequacy of asepsis and antisepsis, it was an operation of the greatest risk to the woman. Only in 1876 did Edoardo Porro succeed in greatly improving the maternal prognosis of cesarean section; this was due both to the establishment of antisepsis in surgery and, above all, to his operative technique: after extracting the fetus from the uterus, exposed following incision of the abdominal wall, he amputated the uterus itself and the ovaries, thus enormously reducing the danger of hemorrhage and infection. But although maternal mortality thereby fell to 15–20%, the operation remained far too mutilating for the woman. Only six years later Kehren and Sänger introduced the “conservative” cesarean section, by which the woman, with the uterus sutured, retained the possibility of further pregnancies. Since then, successive improvements in this fundamental operation of modern obstetrics have reduced maternal and fetal mortality to negligible percentages, while the scar of the uterine wound scarcely compromises subsequent pregnancies at all; indeed, obstetricians today have the possibility of performing further repeated cesarean sections on patients who have already undergone one. Cases of women operated on three or four times are now frequent.
The absolute indications for cesarean section include all those clinical conditions in which delivery cannot take place by the natural passages. For example, considerable pelvic deformity, that is, narrowing of the maternal pelvis in one or more of its diameters, to such a degree as to prevent the fetus from passing through the pelvis itself; tumors that occlude the lower part of the maternal pelvis, etc. But the very low mortality and, above all, the fact that cesarean section does not compromise subsequent pregnancies have enormously extended the scope of indications for the operation, and today it is also performed for clinical conditions in which, until a few years ago, other procedures were employed that placed the lives of mother and fetus at greater risk or compromised subsequent deliveries, or even left the obstetrician uncertain whether to sacrifice the fetus in an attempt to save the mother, for example, by embryotomy operations. It is therefore performed in central placenta previa, sclerosis of the uterine cervix, cases of fetal macrosomia, shoulder presentation, pelvic deformities of moderate degree, etc.
Destructive cesarean section is now performed only in rare, particular circumstances; in these cases, the primary need to save both maternal and fetal life takes precedence over concern for preserving the woman’s uterine function. Post-mortem cesarean section, that is, after the mother’s death, is performed today in the very rare cases in which it is permissible: the fetus may in fact survive the mother by a few minutes; the abdomen and uterus are then opened rapidly, an attempt is made to extract the fetus while still alive, and the woman’s abdomen is then closed with a few stitches. Success is rare and will generally occur when the mother dies not from prolonged illnesses, which would also have injured the child, but from sudden, accidental death.
Emanuele Lauricella
THE C. S. AND CATHOLIC MORAL TEACHING. — 1. If the mother is alive, the C. S. is licit when the following conditions concur: a) that delivery cannot otherwise take place and therefore the death of the mother or child cannot be otherwise prevented; b) that the fetus is viable, that is, capable of living outside the maternal womb in some manner; c) that there may prudently be hope of saving the mother—which in our day, given the great progress of surgery, constitutes the majority of cases; d) that the operation is, naturally, performed by a skilled surgeon. The C. S. would become obligatory if it proved to be the only way of baptizing the fetus; but in practice this will almost never be established, since the fetus can be validly baptized in the maternal womb itself.
2. If the mother is dead, a Caesarean section must be performed on her as soon as possible, both to save the fetus, if possible, and at least to baptize II. The obligation, which is grave, falls upon the surgeon and the physician, and, in their absence, upon anyone capable of performing the operation. A priest may not do so, because of the danger of scandal that could easily result from it (Decr. of the S. Office, 15 Feb. 1780; 13 Dec. 1899, in ASS, 32 [1899], p. 501 ff.); he must, however, endeavor to ensure that the operation is performed as soon as possible by a skilled person. The obligation to perform the C. S. ceases when there is moral certainty of the fetus’s death; it becomes ever more serious, on the other hand, the more months of life it has completed, especially in cases of the mother’s very rapid or sudden death.