Objectives

On successfully completing this topic, you will be able to:

• understand how to anticipate and, to some extent, avoid difficulties encountered at CS

• appreciate the techniques that can help you cope with such difficulties.

Introduction

CS is the process of delivering a baby abdominally. It may be required on fetal grounds or on maternal grounds. Rates vary enormously, not only between countries but also between hospitals, but trends are generally increasing worldwide. In the UK, the CS rate for 2011–12 was 25%, according to the NHS maternity statistics report. This reflects the fact that, in most developed countries, around one in four women will deliver by CS. The caesarean rate continues to rise in developing countries as well, and has now reached 50% in China. CS has become one of the most (if not the most) commonly performed operations in the world.

The decision to perform a CS can be obvious in some circumstances, while in others it can be extremely difficult. This decision-making skill in terms of timing and mode of delivery is acquired over many years, with experience and clinical judgement. CS should never be seen as the easy option. All risks of CS, as opposed to those of proceeding with an attempt at labour and vaginal delivery, should be considered and balanced in each individual circumstance, taking into account both maternal and fetal interests.

This chapter is not designed to list the indications or arguments for CS, nor to give intricate detail into surgical technique, but rather to highlight the difficulties that can be encountered (both anticipated and unexpected) and to suggest ways in which they can be predicted, recognised and dealt with in the acute situation.