18.12 Difficulties with Caesarean section

Many difficulties attend Caesarean section, and many disasters can follow it, so the list below is long. Torrential bleeding when you cut through a placenta praevia can kill a mother. Disasters with the urinary tract are usually the result of very poor technique. Fortunately, most of the others are rare. Some of these many difficulties are only seen in the developing world, where inexpert operators find themselves working under difficult circumstances.

Figure 18.17: CAESAREAN SECTION IN AFRICA IN 1879, as described by Robert Felkin. The mother was liberally supplied wih banana wine, which was also used to wash the operator’s hands and her abdomen. A single rapid lower midline incision opened her abdominal wall and her uterus. Bleeding points were cauterized with a hot iron. After delivery her abdomen was closed with seven thin iron spikes. The baby was put to her breast 2 hours later. Both mother and baby did well. Felkin RW, ‘Notes on Labour in Central Africa’. Edinburgh Medical Journal 1884;29:922. As reported in Medicine Digest 1985;11:17–19