time required for performing the operation and the
somewhat longer hospital stay following the birth.
Complications Related to Cesarean
Delivery
Complications of the birth process may affect ei-
ther the mother or the infant. Whereas the risk of
complications for the mother is somewhat greater in
a cesarean birth than in a vaginal birth, the risk of
complications for the infant is greater from vaginal
birth than from cesarean birth. Moreover, the type
and severity of complications from each method of
birth differs for both the mother and the infant. Com-
plications of cesarean birth for the mother during the
operative procedure include adverse reactions to an-
esthetic agents, injury of abdominal organs and hem-
orrhage from the surgical incisions; and after the
procedure, pneumonia, urinary or wound infections,
and blood clots in the legs, abdomen, or lungs. The
most common long-term complication of cesarean
birth is the risk of rupture of the uterine incision in
a subsequent pregnancy, and the consequent increase
in risk of future pregnancies having to be delivered
by cesarean.
Complications of vaginal birth for the mother in-
clude many of the complications that occur in cesare-
an birth, but they occur much less often and are
usually less severe. The long-term complication of
vaginal birth is the increased risk of pelvic muscle dys-
function that manifest as urinary or rectal inconti-
nence.
Overall, the risk of maternal death from a cesare-
an birth (4 per 10,000 births) is four times greater
than from a vaginal birth (1 per 10,000 births). Cesar-
ean births, however, are often performed for medical
or obstetrical complications that, by their nature, in-
crease the risk of death for mothers. If one excludes
pregnancies with such complications, there still re-
mains a one and one-half times greater risk of the
mother dying as a result of cesarean birth as com-
pared to vaginal birth.
Complications of vaginal birth for an infant in-
clude birth trauma (fractured limbs or injured nerves
resulting in paralysis of an arm), asphyxia (lack of ox-
ygen) causing brain damage, and acquiring an infec-
tion from the mother’s birth canal (herpes simplex
virus or group-B streptococcus). Complications of ce-
sarean birth for infants include lacerations from the
surgeon’s knife and a respiratory illness caused by the
failure of excess fluid to be cleared from the infant’s
lungs.
Balancing the benefits and risks of vaginal birth
as compared to cesarean birth for both the mother
and the infant in a wide variety of birthing situations
is the complex problem faced by doctors and mid-
wives, who care for women during their pregnancies.
Increasingly, women are becoming more involved in
the decisions about the way in which they will give
birth. During her pregnancy, a woman should be pro-
vided with accurate and updated information about
the benefits and risks of the alternative methods of
delivery for her situation so that together with her
physician or midwife she can make an informed deci-
sion about the method of birth.See also: BIRTH; MIDWIVESBibliography
Bowes, Watson, Jr. ‘‘Clinical Aspects of Normal and Abnormal
Labor.’’ In Robert Creasy and Robert Resnik eds., Maternal-
Fetal Medicine, 4th edition. Philadelphia: Saunders, 1999.
Hankins, Gary, Steven Clark, F. Gary Cunningham, and Larry Gil-
strap. ‘‘Cesarean Section.’’ In Operative Obstetrics. Norwalk,
CT: Appleton and Lange, 1995.
Phelan, Jeffrey, and Steven Clark, eds. Cesarean Delivery. New York:
Elsevier, 1988.
Watson A. Bowes Jr.CHILD ABUSE
The world in which many children live is punctuated
by violent act after violent act. In many situations chil-
dren become victims of this violence. Some children
have been the direct targets of an act of violence,
while other children have been indirectly affected
through witnessing such acts; it is often difficult to dis-
tinguish between these two cases based on outward
appearance alone. There are yet other children living
in situations just as egregious where violence does not
play a significant role. Theirs is merely an existence
where their needs are not adequately met, including
basic necessities of food and shelter, protection, struc-
ture, and supervision. Society labels these children as
victims, when in fact they are the truest of survivors.
What greater challenge can there be than having
caretakers who cannot be trusted to provide adequate
care? The common denominator of maltreatment is
that those responsible for the child’s well-being are ei-
ther unable or unwilling to care for the child proper-
ly. Intervention from others is warranted to ensure
that the needs and welfare of the child are fully con-
sidered.Definitions of Child Maltreatment
The phrase ‘‘child abuse’’ often immediately
brings to mind the image of a child beaten black and
blue by an angry parent or caregiver. This is merely
one scenario and perhaps the easiest to contrive be-
cause one can see what has been done to the child. It76 CHILD ABUSE