Elective Caesarean Section - Indication Based

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 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.

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