CESAREAN, SECTION. - It is the extraction of the fetus and the adnexa through the uterine wall. The name seems to derive from the description that Pliny the Second, in his natural history, gave of the birth of Scipio Africanus: « a caeso matris utero ».
Certainly an ancient practice, it was performed, until almost our own days, either on a dying woman as a last attempt to save the fetus, or in the decision to sacrifice the mother's life rather than the fetus's. This is because, given the primitive technique (the unsutured uterus was generally left in the abdominal cavity, thus causing hemorrhage and infection) and the lack or insufficiency of asepsis and antisepsis, it was an operation of very great risk for the woman. Only in 1876 did Edoardo Porro succeed in greatly improving the maternal prognosis of the cesarean section; this both because of the establishment of antisepsis in surgery and, above all, because of his operative technique: having extracted the fetus from the uterus exposed after incision of the abdominal wall, he amputated the uterus itself and the ovaries, thus enormously reducing the danger of hemorrhage and infection. But if maternal mortality thus fell to 15-20%, it nevertheless remained an operation too mutilating for the woman. After only 6 years Kehren and Sänger carried out the "conservative" cesarean section, by which the woman, with the uterus sutured, was left the possibility of further pregnancies. Since then, successive refinements of this fundamental operation of modern obstetrics have brought maternal and fetal mortality down to negligible percentages, and the scar of the uterine wound hardly affects subsequent pregnancies at all; indeed, today the obstetrician is offered the possibility of performing further repeated cesarean sections on patients already delivered by cesarean section. Cases of women operated on up to 3-4 times are by now frequent.
The absolute indications for cesarean section are all those clinical conditions in which delivery cannot take place by the natural routes. For example, marked pelvic deformity, that is, the narrowness 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 minimal mortality, and above all the fact that cesarean section does not jeopardize subsequent pregnancies, have enormously extended the field of indications for the operation, and today it is performed even for clinical conditions in which, until a few years ago, recourse was had to other interventions that put the life of the mother and fetus at greater risk or jeopardized subsequent deliveries, or even placed the obstetrician in doubt as to whether to sacrifice the fetus in order to attempt to save the mother, for example, with embryotomic operations. It is therefore performed in central placenta previa, in sclerosis of the uterine cervix, in cases of fetal macrosomia, in cases of shoulder presentation, in pelvic deformities of no excessive degree, etc.
The destructive cesarean section is performed today only in rare, particular conditions; in these cases the primary need to save the two lives, maternal and fetal, causes the concern to preserve uterine function in the woman to take second place. The post-mortem cesarean section, that is, after the mother's death, is performed today in the very rare cases in which it is permitted to do so: in fact the fetus can survive the mother by a few minutes; the abdomen and uterus then being rapidly opened, an attempt will be made to extract the fetus still alive, and the woman's abdomen will then be sutured with a few stitches. Success is rare and in general it will occur when the mother dies not from prolonged illnesses, by which the child too is consequently damaged, but from sudden, accidental death.
Emanuele Lauricella
THE CESAREAN CUT AND CATHOLIC MORALITY
1. If the mother is alive, the t. c. is licit when the following conditions concur: a) that the birth cannot otherwise take place and therefore the death of the mother or of the child cannot be averted in any other way; b) that the fetus be viable; that is, able in some way to live outside the maternal womb; c) that one may prudently hope to save the mother; which in our days, given the great progress of surgery, constitutes the majority of cases; d) that the operation be, naturally, performed by a skilled surgeon. The t. c. would become obligatory if it proved to be the only way to succeed in baptizing the fetus; but in practice this will almost never be certain, since the fetus can be validly baptized within the maternal womb itself.
2. If the mother is dead, she must be subjected to cesarean section as soon as possible, both to save the fetus, if possible, and at least to baptize it. The obligation, which is grave, falls upon the surgeon and the physician, and, in their absence, upon whoever might be capable of performing the operation. It is not licit for the priest, because of the danger of scandal that could easily arise from it (Decr. of the Holy Office, 15 Feb. 1780; 13 Dec. 1899, in ASS, 32 [1899], p. 501 ff.); he must, however, strive so that the operation be performed as soon as possible by a skilled person. The obligation to perform the t. c. ceases when one has moral certainty of the death of the fetus; it becomes instead ever more grave, the more months it counts of life, especially in cases of very rapid or sudden death of the mother.