When is an elective C-section not elective?

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!

5 Responses

  1. EXACTLY!!!
    I look at mums who say ‘oh I had an emergency cesarean!’ and say how sorry I am and how scary that must have been.
    They think I’m insane… ONLY ONE!!! ONE!!!!! had a crash section under full sedation.
    the rest were, well I was induced, then this then that… or my water broke and then they told me that I wasn’t going in to labour and the baby would die…
    Iotrogenic is NOT an emergent situation.
    As usual. Brilliant post!

  2. Y’know, I just recently read something that defined “emergency C-section” as any C-section which was not planned. And this wasn’t some woman’s blog post or something — it was the definition used in a study! I forget where it was — I was researching something else and happened to come across that and didn’t save it — but it just flabbergasted me. No wonder the rate of “emergency” C-sections are so high, if any unplanned surgery is coded as an emergency! And then the moms are almost encouraged to use the term “emergency” when it was merely “unplanned” (and perhaps even unnecessary)…

  3. AMEN! This is so true. I think there should be many definitions of cesareans. Very few are actually “elective” most I would say are coerced, though the moms may not realize it. I doubt that the OBs would label something as coerced though. 🙂

  4. I agree, categories would be nice, it does skew the statistics a bit, but I’m thinking the doctors prefer it when they can say it was the woman’s choice.

  5. I agree that options should be given. That a doctor should not coerce their patients. But what should also be considered is the situation. I had planned for a natural birth with an option for pain meds if I wanted them. Turns out that my went into labor but my cervix didn’t dialate, my baby was in serious distress. My doc tried everything to correct what was going on, but a C was my fate. I am thankful and greatful to my doc for informing of what was going on. Our son was born, blue as smurf, cord wrapped 4x around his little neck. My doc said had I been about 8cm or so he would have let me go through with the vaginal delivery but because my cervix was stuck at 2cm and ephasing he felt the best move was to do a C. He saved my sons life and now he is almost 3yrs old. I due in December with #2 and my doc said its my choice what I want to do, VBAC or C. He supports me either way. I think most importantly we need to remember that the choice to have a C or not is personal, no one should be made to feel bad about it. Everyone is opinionated these days and less supportive than ever. To have a C doesn’t make you less of a mother…in the end we are all still Mothers. So all the haters need to get over themselves.

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