Elective caesarean section

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Elective caesarean section, also called a planned caesarean section, is an elective surgery, which simply means that it is scheduled in advance rather than performed because of an unscheduled emergency. It is a caesarean section (CS), which is the surgical childbirth of an infant through an incision in the belly of a pregnant woman. Elective caesarean sections may be performed on the basis of an obstetrical or medical indication, or also because of a non-indicated maternal request for the caesaean section.[1] Elective caesarean sections may be medically indicated for a range of reasons, but when they are not indicated, various health authorities recommend that they not be performed for a range of reasons including preventing harm of unnecessary health care to both parent and child.

Indication based[edit]

When it is clear during a pregnancy, but prior to labor, that there is a medical or obstetrical reason to choose delivery via caesarean section, physicians will commonly perform the operation at a scheduled time, rather than waiting for the onset of labor. Such planned caesarean sections are performed for many reasons, including history of previous caesarean section, placenta previa, abnormal presentations, multiple pregnancy, known obstructions of labor, medical conditions (such as heart disease). The advantages of performing the delivery at a scheduled time include use of daytime services when hospital resources are optimal, and the ability to plan and prepare for the event. The approach has risk in that the surgery may be scheduled too early resulting in premature or compromised delivery. Prenatal testing mitigates this risk.

Critics of elective caesarean section, maintain that decision metrics are ambiguous, and that trial of labor would often be successful without open abdominal surgery. The cost to the patient and the baby for unnecessary surgery may be substantial. Critics also argue that because physicians and institutions may benefit by reducing night time and weekend work, that an inappropriate incentive exists to suggest elective surgery.[2]

The fear of litigation is cited to drive the elective caesarean section rate higher:[3] While a repeat caesarean section can be avoided for many women who wish to labour after a caesarean,[4] (a process called vaginal birth after caesarean section, or VBAC), some argue that this can lead to an increase likelihood of uterine rupture.

Special cases[edit]

For women who have had previous caesarean surgeries, a medical review found no strong medical evidence to guide decisions about whether a woman should have a caesarean or planned vaginal birth after caesarean.[5] Another review found no strong medical evidence to guide a decision between a caesarean versus a planned labor induction.[6] There is no widely accepted strategy by medical authorities for inviting women who have had previous caesarean surgeries into shared decision-making processes for deciding whether to use caesarean or vaginal for subsequent births in their personal cases.[7]

When preterm birth is scheduled for single babies (not twins), evidence does not give guidance on whether labor induction or c-section should be used.[8]

A medical review has been unable to find appropriate clinical research on which a practice recommendation can be made about the risks and benefits of a mother having caesarean sections for non-medical reasons.[9]

Caesarean delivery on maternal request[edit]

Caesarean delivery on maternal request (CDMR) is a medically unnecessary elective caesarean section, where the conduct of a childbirth via a caesarean section is requested by the pregnant patient.[1]

References[edit]

  1. ^ NIH (2006). "State-of-the-Science Conference Statement. Cesarean Delivery on Maternal Request". Obstet Gynecol 107 (6): 1386–1397. doi:10.1097/00006250-200606000-00027. PMID 16738168.  See also [1]
  2. ^ Vernon, David (2005). Having a Great Birth in Australia. Australian College of Midwives. p. 25. ISBN 0-9751674-3-X. 
  3. ^ Kwee A, Cohlen BJ, Kanhai HH, Bruinse HW, Visser GH (2004). "Caesarean section on request: a survey in The Netherlands". Eur J Obstet Gynecol Reprod Biol 113 (2): 186–190. doi:10.1016/j.ejogrb.2003.09.017. PMID 15063958. 
  4. ^ Michael J. McMahon et al. (1996). "Comparison of a Trial of Labor with an Elective Second Cesarean Section". NEJM 335 (10): 689–695. doi:10.1056/NEJM199609053351001. PMID 8703167. 
  5. ^ Dodd, Jodie M; Crowther, Caroline A; Huertas, Erasmo; Guise, Jeanne-Marie; Horey, Dell; Dodd, Jodie M (2013). "Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth". doi:10.1002/14651858.CD004224.pub3. 
  6. ^ Dodd, Jodie M; Crowther, Caroline A; Dodd, Jodie M (2012). "Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth". doi:10.1002/14651858.CD004906.pub3. 
  7. ^ Horey, Dell; Kealy, Michelle; Davey, Mary-Ann; Small, Rhonda; Crowther, Caroline A; Horey, Dell (2013). "Interventions for supporting pregnant women's decision-making about mode of birth after a caesarean". doi:10.1002/14651858.CD010041.pub2. 
  8. ^ Alfirevic, Zarko; Milan, Stephen J; Livio, Stefania; Alfirevic, Zarko (2013). "Caesarean section versus vaginal delivery for preterm birth in singletons". doi:10.1002/14651858.CD000078.pub3. 
  9. ^ Lavender, Tina; Hofmeyr, G Justus; Neilson, James P; Kingdon, Carol; Gyte, Gillian ML; Lavender, Tina (2012). "Caesarean section for non-medical reasons at term". doi:10.1002/14651858.CD004660.pub3.