TO DO OR NOT TO DO A CESAREAN SECTION

During a period of 21 years, in an institution where 40,423 deliveries were performed, there were 4,397 cesarean sections. The maternal mortality for these was 0.081 % as compared with 0.052% for vaginal deliveries, and in the series of 1,826 elective repeat cesarean sections the maternal mortality was zero. Dictums expressing fear of this operation generally ignore recent improvements in anesthesia, surgery, and obstetrics. There has been too much emphasis on the frequency of cesarean sections in various hospitals as the chief test of obstetrical conservatism. The frequency of maternal and fetal deaths is the more reliable test, and the ideal should be a perfect end-result for both baby and mother. This should include preservation of vaginal functions, which are too often deranged seriously by the tears, infections, and other trauma of vaginal deliveries. Close attention to indications and technique of cesarean section should increase the percentage of pregnancies that terminate happily for all.