Elective caesarean section

Elective caesarean section (AE elective cesarean section) refers to a caesarean section (CS) that is done on a pregnant woman who is not in labor, either on the basis of an obstetrical or medical indication or at the request of the pregnant patient.^[1] The elective CS is therefore also a "planned CS". In contrast, a CS done during labor by necessity is termed an emergency caesarean section.

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Indication based

When it is clear during a pregnancy, but prior to labor, that there is a medical or obstetrical reason to choose delivery via a CS, physicians will commonly perform the operation at a scheduled time, rather than waiting for the onset of labor. Such planned CSs are performed for many reasons, including repeat caesarean sections, placenta previa, abnormal presentations, multiple pregnancy, known obstructions of labor, medical conditions (such as heart disease), and more. The advantages of performing the delivery at a time of choice include use of daytime services when staffing and access to resources are at the maximum, and the ability to plan and prepare, both on the patient’s side and her family as well as on the healthcare provider’s side. The risk of the approach is that the timing of the CS could be set too early and that the baby then could be premature or compromised. Prenatal testing usually safeguards against this complication.

Critics of this practice maintain that too often the indications are too soft, that a trial of labor could have been successful, and that physicians and institutions may benefit inappropriately by reducing night time and weekend work and do so at the cost of the patient who may undergo an unnecessary procedure, or to the detriment of the baby that would benefit from a natural delivery. ^[2]

The fear of litigation is cited to drive the elective CS rate higher:^[3] While a repeat CS 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.

Patient request

Main article: Caesarean delivery on maternal request

Increasingly, CSs are performed in the absence of obstetrical or medical necessity at the patient's request, and the term the term Caesarean delivery on maternal request has been used.^[1] Another term that has been used is "planned elective cesarean section".^[5] As of 2006, there is no ICD code, thus the extent of the use of this indication is difficult to determine. The mother is the only party who may request such an intervention without indication.

See also

• Caesarean section

References

1. ^ ^{a b} NIH (2006). "State-of-the-Science Conference Statement. Cesarean Delivery on Maternal Request". Obstet Gynecol 107: 1386-97, also [1].
2. ^ Vernon, David Having a Great Birth in Australia, Australian College of Midwives, 2005, p25 ISBN 0-9751674-3-X
3. ^ Kwee A, Cohlen BJ, Kanhai HH, Bruinse HW, Visser GH. "Caesarean section on request: a survey in The Netherlands". Eur J Obstet Gynecol Reprod Biol. 2004 Apr 15;113(2):186-90.
4. ^ Michael J. McMahon et al. Comparison of a Trial of Labor with an Elective Second Cesarean Section.
5. ^ Hannah, Mary E.. Planned elective cesarean section: A reasonable choice for some women?.