EMERGENCY OR ELECTIVE

It’s one of the peculiar twists of medical language that any unplanned caesarean is referred to as an “emergency”, even though the decision to operate is quite often not taken under emergency conditions. Nobody can predict when a caesarean may be necessary. The only proving ground is a period of labour. Should labour genuinely not be progressing, should the mother become tired or unwilling to go on, there is usually plenty of time to site an epidural, let the mother rest and then operate.

Elective caesareans when the baby is delivered surgically on an elected date before the mother goes into spontaneous labour are rarely necessary or desirable except in circumstances where the mother’s or baby’s health may be severely compromised by labour. An elective repeat caesarean carries a greater risk of serious complications in the next labour (Am J Ob Gyn, 1990; 163: 738-42) and six times greater risk of death than a vaginal birth (Pursing the Birth Machine, Ace Graphics, 1995).In spite of this, a substantial number of caesareans are elective and for non medical reasons (Lancet, 1993; 341: 246; Birth, 1992; 19: 21-2). Some doctors even claim that this is justified because it is in response to women’s wishes. What may prompt a significant proportion of healthy women to ask for or accept unnecessary surgery may be linked to a very deep fear of the process of birth in women and their practitioners. As one American obstetrician noted, “When someone is scared it is not an indication for surgery. It is an indication for education.” (OBG Mgt, March 1991).

Even if a caesarean is unavoidable, there is considerable evidence to show that a baby can benefit from a period of spontaneous labour (Sci Arena, April 1986; 92-102, Ob Gyn, 1985; 65: 818-24). Stress hormones, known as catecholamines, released during labour, trigger the baby’s lungs to begin drying out in readiness for life in an airy environment. These hormones also stimulate the liver, kidneys and digestive system to begin to function independently. Elective caesarean deprives the baby of this important preparation for life.