What is the elective caesarean section? Features "Caesarean optional"

A cesarean section is considered to be a sparing and careful obstetric operation. When it significantly reduces the risk of birth injuries in children, women can not worry about the painful period of contractions and attempts - they will not.

That is why the number of pregnant women who dream of having an operation of their own accord is growing. Whether it is possible to make an elective caesarean section in Russia, what regulatory bases exist, we will tell in this article.

The term "elective" means "selective." That is, an elective caesarean section refers to a delivery operation, which is done to a woman of her own choice, desire, without having medical indications for surgery.

In the USA and Europe, caesarean sections account for about 30% of all deliveries. This means that every third American or European woman gives birth on an operating table under general anesthesia with the help of surgeons. At the same time, about half of the cases are an elective caesarean section. At her own request, a woman can perform an operation solely for money by entering into a contract with the clinic of interest.

In Russia, the possibility of carrying out operational deliveries of their own free will is theoretically not excluded for women, but in practice there are a lot of bureaucratic and legislative difficulties. So, doctors recognize a woman’s right to an independent choice, but they are guided by Letter of the Ministry of Health of 2014 No. 15-4 / 10 / 2-3190.

This document for internal use denotes a strict list of indications for cesarean section, and the freedom of choice does not appear in it. In other words, the mother’s refusal of natural childbirth as a reason for the operation is not considered.

We carefully studied this letter and found out that the indications for surgery are:

• complete and partial presentation of the placenta (with incomplete surgery, there must be signs of bleeding);
• early placental abruption, regardless of its location;
• two or more cesarean section in history, as well as other operations on the uterus, after which there are scars and there is a risk of their discrepancies in labor;
• transverse, oblique or pelvic presentation of the fetus, especially if the fetus weighs more than 3600 g;
• pelvic position of the first child of twins in multiple pregnancies, improper presentation of any of the babies;
• gestational age is more than 41 weeks with no effect of stimulation of labor;
• mechanical obstacles - scars on the neck, sutures on the perineum after the third degree ruptures in previous births, tumors, neoplasms;
• severe preeclampsia, preeclampsia;
• any ailments in the parturient woman in which it is impossible to have a fit (myopia, pathologies of the heart and blood vessels, a transplanted kidney);
• acute fetal hypoxia;
• umbilical cord prolapse;
• HIV infection in the absence of treatment during gestation;
• primary genital herpes;
• clinically narrow pelvis;
• violations of blood clotting of the fetus, as well as other defects of its development - omphalocele, gastroschisis and others.

The list of those who can count on a cesarean section ends.For other women, the decision is made at their own peril and risk, and doctors are not always willing to take responsibility for the consequences of the operation if she initially had no reason listed in this document.

If in the USA, a woman who voluntarily chooses an operation is given a multi-page contract for signing, in which doctors absolve themselves of responsibility for absolutely everything, including complications and the death of a woman on an operating table, then in Russia no one can offer you such a contract. In addition, the principles of bioethics do not allow doctors to harm the patient, and cesarean section, whatever one may say, has implications for the health of the mother.

In most maternity hospitals, clinics and perinatal centers of the country, a woman who will ask if it is possible to choose an operation on her own without medical indications will simply be politely referred to other medical specialists, such as psychiatrists and psychologists, so that they can carry out explanatory work and help cope with the fear of birth pain. .

But some perinatal centers will not refuse, although they will designate that this service is paid. According to the data of August 2018, an elective caesarean section can be performed at the Moscow Medical and Medical Center in Moscow depending on the doctor’s qualifications, the number of fruits, for a rather impressive amount: the minimum cost is 260 thousand rubles, the maximum is 540 thousand.

Of course, the clinical recommendations of the Ministry of Health about the caesarean section and the indications for it in these centers were read and known, but they use the legislative "space", because the COP at will, although not described in the document, is not actually prohibited.

The risk of infection, the formation of an insignificant scar on the uterus, bleeding and atony of the uterus is only an incomplete list of what a quite healthy woman can expect, who can and should avoid such consequences.

The influence of the surgical effect on children is still being studied, but already now some pediatricians claim that children after Cesarean section are more vulnerable, the likelihood of respiratory failure in them, as well as weak immunity, susceptibility to allergies, disorders of the intestinal flora are ten times higher than that of children born naturally.

The fact that with a scar on the uterus is more difficult to bear the next pregnancy, that recovery after surgery is longer and sometimes painful for the puerperal, the pregnant woman is told first of all. If she continues to insist on a cesarean section, then she will be redirected to private centers, where labor will cost her a round sum.

It should be noted that the doctors of these centers, following the example of their American and European colleagues, disclaim most of the responsibility for complications - the consequences of a cesarean section for which there was no evidence. After signing such a contract, a woman must understand that she will be approached in court in which case it will be almost unpromising, since she has subscribed to the fact that she has been informed about the likelihood of various consequences and fully agrees with them.

According to the women, the elective caesarean section is mainly interested in those who have experience of very difficult first birth, experience of death or disability of the baby during childbirth. Because of the fear of childbirth or unwillingness to spoil the genital tract, such a COP is chosen less frequently.

You will learn about when a cesarean section is needed in the following video.