In doing a recent post, I came across a case study about a woman whose uterus ruptured at 32 weeks for no apparent reason. After discussing the interesting features of the case, the authors said this:
“She was advised that future pregnancies would be monitored carefully and delivery would be achieved electively by Caesarean section.”
Now, I’m not denying that a C-section in her case is a good idea, but to tell her that all her babies would be born electively by C-section? I’d think that a ruptured uterus at 32 weeks for no apparent reason is an excellent medical indication for required, not “elective” C-sections. If she had a choice in the matter, then it seems like it would have said, “She was advised that… delivery should be by Caesarean section.” But it didn’t say “should” or “ought” or “preferable” — it said would.
This reminds me of a previous post of mine on the apparent increase in “maternal request” or “elective” C-sections, and whether it is accurate. If this woman (and others like her whose doctors refuse to allow a C-section end up coding the surgery as “elective”) are counted by researchers as “elective” then it looks like “too posh to push” or “maternal request” C-sections are on the rise, when they may not be.
If women are not allowed to choose a vaginal birth, then why are their subsequent C-sections coded as elective?
There really should be more codes, and more detailed and explicit codes, as well, to deal with this rising problem. I’m not going to get into the debate over why the C-section rate is as high as it is — a large part of it is due to defensive medicine and VBAC bans, but the number of truly elective C-sections may be rising as well — but that’s not my purpose for this post.
C-sections are done for numerous reasons, and it really would be nice for statistical purposes to have a little check-box to indicate the primary reason for the surgery. There could be categories like “emergency” (for true code-blue, absent fetal heart-rate C-sections), “urgent” (the C-section is necessary and takes place quickly, but nobody is racing down the hall), “medically indicated non-emergency” (with preferably some of the most common reasons given, such as failed induction or cephalopelvic disproportion [even though the diagnosis is questionable], breech or transverse lie, IUGR, etc.), “maternal fatigue” (which distinguishes between “too posh to push” elective C-sections and those in which the mom is just done, like my sister-in-law who had a 40+ hour active labor, and for whatever reason couldn’t push out her son, although his heartbeat was still fine and the doctor would have allowed her to keep going for a while), “VBAC not allowed” (which possibly removes some of the bitterness that undoubtedly arises from women whose doctors refuse to allow them to try to give birth vaginally but then code it “elective”), “elective repeat C-section,” etc.
I’ve never had a C-section, but it just gripes me that women are said to be choosing C-sections, when the reality is, many of them are not allowed to choose vaginal birth. But then doctors say the C-section was their choice. Hah! Some choice!