Mass General Hospital

Harvard Medical School

Auto-Caesarean Section: A Review of 22 Cases

An auto-Caesarean sections is a type of self-surgery in which a woman attempts to perform a Caesarean section on herself.  Not only is this practice very rare, but also the cases in which it does occur have  not been studied.  In order to better understand this phenomenon,  Szabo and Brockington conducted a review of the available literature to find cases of auto-Caesarean section with the intention of assessing both the situation and motivation of the mothers who perform them.

Twenty-two cases were found, and 19 of those had sufficient information to include in this analysis.  Ranging from as early as 1785 up to 2012, the cases occurred mostly in Eastern Europe, Russia, and the U.S.  These 19 cases were divided into three categories: auto-Caesarean section as a means of feticide, auto-Cesarean section in mentally ill women, and auto-Caesarean section as an act of desperation.

In 7 out of the 19 cases,  mothers attempted to get rid of an unwanted child (essentially acts of pregnancy termination). Women who did this were most often unmarried or involved in extramarital affairs. These cases occurred at an advanced stage of gestation and are thus considered feticide and not infanticide (which is typically defined as killing a child within a year of birth).

The women were mentally ill in 4 out of 19 cases, and the motivation for action was unclear.  These women had known histories of psychiatric symptoms according to family, friends, or physicians.  In one case, the woman gave birth vaginally, yet would not acknowledge it, and still performed an auto-Cesarean section.  The other three cases involved the procedure within the last trimester of pregnancy.  The cases that fell under this category were considered forms of self-mutilation by the authors.

In 8 of the 19 cases, women completed an auto-Caesarean section as a method of ending prolonged or painful labor.  Studies show that obstructed labor and the agony that accompanies it can arouse feelings of rage, frustration, and even suicidality (Brockington 2007).  This group of cases reflects a public phenomenon that has recently come to light: the lack of modern obstetric services in third-world nations.  According to WHO’s 2016 data collection, less than one half of births in sub-Saharan Africa are attended by skilled health personnel (i.e. a physician, midwife, nurse).  Uncoincidentally, this is also the region where maternal mortality is the highest.

Overall, this study completed an in-depth look at the motivations behind auto-Caesarean sections.  Interestingly, the majority of these cases were not caused by mental illness as might be expected, but rather by prolonged or obstructed labor.  Ultimately, this study points to the significance of having skilled professionals in delivery and emergency obstetric services in developing countries.  While auto-Caesarean sections are not a common event, they are one of many problems associated with inadequate attention to reproductive health.

Lauren Kobylski

 

References:

  1. Szabo A, Brockington I. Auto-Caesarean section: a review of 22 cases. Archives Of Women’s Mental Health. 2014;(1):79.
  2. Brockington I. The present importance of the organic psychoses of pregnancy, parturition and the puerperium. Archives Of Women’s Mental Health. 2007;10(6):305-306
  3. Skilled attendants at birth. World Health Organization, 2016

 

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