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Elective and emergency - they don't mean what you think they mean

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
I’ve been writing a bit lately about language use in maternity care. And here’s one that I thought deserved its own post: Elective caesarean and emergency caesarean. I so often see people talking about elective caesareans as though it means the woman actually wanted it for no reason at all and talking about emergency caesareans as though they are all life and death. But this just isn’t true.

If you had an elective caesarean that doesn’t mean you necessarily elected to have one. It means that it was planned prior to labour beginning. Elective caesareans are done for a wide range of reasons including:

Genuine medical reasons like placenta praevia, placenta accreta, or a pre-existing medical issue with mum or bub. I would also add a true fear of childbirth (known as tokophobia) and reasons relating to previous sexual assault as “medical” reasons as I firmly believe that a woman’s mental health is every bit as important as her physical health.

There may also be non-medical indications for a planned caesarean based on care provider preference such size guess or having previously had a caesarean. I know of many women who talk of being coerced, manipulated or downright bullied into an “elective” caesarean because it was their care provider’s preference. Not very “elective” in my opinion.

And there may, of course, be non-medical reasons based on maternal preference. Some women (not as many we are led to believe though) would simply prefer their baby enter the world by caesarean. Some of these women have used their B(enefits)R(isks)A(lternatives)I(ntuition)N(ext) and decided it is best for them and some lack knowledge about the true risks, benefits and alternatives but decide to go with a caesarean anyway.

Wikimedia Commons

Emergency caesareans are those which are done once labour has commenced. It doesn’t mean there is an actual emergency. In fact a number of emergency caesareans take place an hour or more after the decision has been made to have one – both of mine did and I know that it’s not uncommon. These are often performed for things like: failure to progress (failure to dilate according to hospital policy / failure to wait), obstructed labour, low grade foetal distress, maternal exhaustion and malpositioned bub. Sometimes these may also be performed for things like an “undiagnosed” breech (as if breech is a disease?!) or if, during a twin birth, the second twin has problems after the first has been birthed (such as turning transverse). I’ve also heard of women being given an emergency caesarean for things in one hospital (meconium stained liquor, breech, waters broken for a certain period of time) and not in another hospital. Which makes me wonder: how many emergency caesareans are performed for hospital policy related concerns rather than actual health related concerns?

Caesar's Mushroom, Wikimedia Commons

A crash caesarean is an EMERGENCY. This is a situation where either yours or your baby’s life is in true danger. These are performed rarely and are used for things such as: sudden and severe foetal distress that doesn’t recover, cord prolapse, catastrophic uterine rupture and placental abruption. It’s usually very obvious if you are having a crash caesarean (sometimes called a code blue or other colour / number depending on hospital) as people will be rushing around setting things up and moving you towards theatre, while they are also asking you to sign papers, or they will be asking your partner to sign the papers for you. These surgeries will usually be done under a general anaesthetic unless a fully functional epidural is already in place.

So many women undergo elective caesareans they don’t feel they had any choice about and emergency caesareans they don’t feel were even remotely necessary, let alone “emergency”. So this information is definitely worth keeping in mind when next discussing caesareans.
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