How Many Caesareans?

With Mrs. John F. Kennedy scheduled to have her third baby by caesarean* section this summer, the operation is likely to become as well publicized as the President's 50-mile hikes. For healthy mothers, it is hardly more dangerous. Many women still fear a succession of caesareans and believe that the third must be the last; after that, they think, the risks are too great, and the only thing left is to have a hysterectomy to prevent future pregnancies. Fact is, such fears are usually communicated to women patients by obstetricians who are still devoted to out-of-date ideas. Today there is no sound medical reason why a healthy woman should not have eight (or even more) babies by caesarean.

Old Fallacy. As though anticipating the Kennedy caesarean, three obstetricians at Washington's Providence Hospital have just reviewed their experience over eleven years (1952-62 inclusive), in what they point out is "a community hospital under religious [meaning Roman Catholic] supervision, where sterilization is not permitted except for definite pathology."

In those eleven years, say Dr. Jean E. Paquin and his colleagues, 1,030 deliveries were by caesarean section--one out of every 35. For 38 of the women, it was their fourth delivery by this means; for twelve, it was the fifth; for four, the sixth; for one, the seventh; and for two, the eighth.

The idea that a woman should have a hysterectomy or have her ovarian tubes tied off after the third caesarean, say the D.C. doctors, is a fallacy dating back a quarter-century, when the incision for the delivery was made vertically through the upper part of the wall of the womb. This is the thickest, most muscular part, and is also closest to other vital organs that may be damaged in the operation.

New Cut. Now, except in emergencies, up-to-date obstetrical surgeons usually make a curved cut across the lower part of the pelvis (technically, a laparotrachelotomy, or transverse cervical section) into a thinner part of the uterus. This carries far less risk of damage to the womb itself or to other organs --and, incidentally, leaves the woman free to wear a bikini afterward without embarrassment.

The operation, Dr. Paquin believes, is no more dangerous than it is for a grown woman to have her tonsils out. One obstetrician who agrees is Dr. John W. Walsh, 50, who expects to perform the fourth caesarean on Jackie Kennedy.

* Legend has it that Julius Caesar was born by such surgery, but in those days the operation was performed only on women who died in labor, and by Caesar's own account, his mother was alive when he was 48 years old. Other popular explanations: if a Roman woman died pregnant, the operation was required by the emperor's law--Lex Caesarea--thus a caesarean section. Or the name may be derived from the Latin verb caedere, to cut.

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