Caesarean delivery on maternal request

Request caesarean section (WCS, Wunschsektio, Wunschsectio, elective cesarean section ) is a term for a caesarean section, which is not medically necessary, but may be conducted at the request of the mother.

Is to ensure reimbursement by the health insurance, they will be declared as medically necessary, for example, so that no longer statistically detectable if there is a request caesarean section or not. One of the main reasons for the decision to the primary caesarean section, which also include the request caesarean sections, are in addition to the recommendation of the doctor or midwife ( 73%) of the adverse situation of the child ( 41%) and fear for the child ( 39%).

Statistics

In the year 2003 175.341 women (25.5 percent) delivered by Caesarean section in Germany, in 2012 there were 208 254 ( 31.9 percent). Among the states there was the highest proportion in Hesse observed, the lowest share in Saxony. The German government sees as reasons for the rising caesarean section rate among other things, an increasing proportion of high-risk pregnancies among pregnant women as well as improved risk-benefit evaluations in individual cases due to improved surgical and anesthetic techniques.

Among the data available for the 2011 C-section rates twelve European countries were Italy ( 37.7 percent ) and Romania ( 36.3 percent) to observe particularly high C-section rates in Finland and Sweden particularly low ( 16.2 percent each ). In Germany, the cesarean section rate was 31.1 percent.

In-depth statistical data with number of request caesarean sections are hardly available. A survey of 4,200 insured in the Barmer GEK mothers in February 2012, however, found that only 2 percent of the mothers interviewed have expressed the desire to have a caesarean section. Women feel although at birth by a technology - intensive care safer, but it does not spring the desire for a caesarean section.

Arguments of request caesarean supporters

As a benefit of cesarean section over a natural birth, the predictability of the birth date may be considered. In addition, the actual birth process with a caesarean by anesthesia almost completely pain-free is ( but this is largely unachievable even with natural childbirth by a epidural ), but the usual surgical pain come after cesarean section. The wait time in the hospital is only five to seven days today. The scar after caesarean section runs below the bikini line and is about 15-20 cm long, in contrast to earlier times, so much less conspicuous.

Proponents of request caesarean see him as an equal treatment alternative to " natural childbirth " and refer to the self-determination of women, the Viennese gynecologist Wolfgang Grin.Die decision for or against a medically necessary caesarean section should only be taken by the mother after this over pros and Cons of midwives and doctors were elucidated.

Even advocates argue that having " more beautiful " head shapes children born by cesarean section because the deformation of the child's skull is eliminated during passage through the birth canal. A few hours after birth, the head shapes of normal infants, however, are also normalized.

The caesarean section is not difficult with the current state of research, the mother - child bond, as well as running for particularly traumatic natural birth is not the case. Possible psychological problems and feelings of failure of the mother after a caesarean section are more the result of lack of information and the pressure of the social environment.

Benefits of a caesarean compared to a vaginal delivery are: decreased risk of ignition by pregnancy remains, no conjunctivitis due to infection in the birth canal, avoiding pelvic problems in the baby, no birth injuries in the vaginal area, prevention of urinary and fecal incontinence after perineal tears.

Arguments of request caesarean critics

On the other hand it is argued that the cesarean section leads to temporary adaptation problems in the child. Adaptation problems are occurring immediately after birth ( postnatal) adaptation problems of the child. The physiological reason is the changeover of the circulatory system after birth pulmonary breathing. A BORN naturally child is squeezed filled with amniotic fluid lung during the passage of the birth canal, which is absent through the abdominal wall with childbirth. The clinical signs are decreased heart rate ( bradycardia) and respiratory disorders. The breathing disorders are not about morphological or biochemical disorders or diseases of the lungs, but a lack of impulse to breathe. Such children need sometimes oxygen and ventilatory support. The whole thing usually lasts no longer than a few minutes, but it can also make a transfer to a children's hospital necessary.

In a natural birth these disorders occur significantly less often because the children are prepared by the release of stress hormones during childbirth at first breath, the lungs are free of amniotic fluid.

Not to be confused is the adaptation disorder with respiratory distress syndrome ( neonatal respiratory distress syndrome ) of preterm infants. This problem occurs especially when the cesarean section is performed on the scheduled date, without the labor has started, as a study with 34,000 babies of Danish university hospital in Aarhus showed.

The disadvantages for the mother are increased mortality ( approximately 1:15,000 instead of 1:50,000, but the involvement of emergency caesarean sections, which reduces the value of this statistic ), a slightly increased risk for a placenta - deep seat in subsequent pregnancies and a slightly increased risk of infections associated with the operation. An additional risk is an increased risk of rupture of the uterus in the cutting area. A tear of the uterus in the old scar area can occur during birth through the contractions and can be life-threatening by an unrecognized bleeding. However, this is a rare complication, the risk is 0.4 %.

It is discussed whether also an increased infant mortality rate applies. Here the opinions of twice as high mortality as in the natural birth differ to the same mortality in cesarean sections as in the natural birth. However, current studies suggest a slightly increased risk of mortality in elective caesarean sections.

Previously it was the formula: Once a Caesarean section - always caesarean section. From this generalization it is now largely moved away. However, almost a quarter of all caesarean sections makes the so-called "re- cesarean section " in Germany ( 23.6 percent in 2010 ), ranking ahead of poor heart sounds ( 20.8 percent of all cesareans ) and birth arrest ( 16.4 percent) than reason for choosing a cesarean section. The assumption that a natural birth after a previous caesarean section was too dangerous, is widespread. Although increases after caesarean actually the risk of serious complications, but these are very rare. In addition, the waiver of the emotional experience of birth and the waiver of the bonding is called a disadvantage often.

Natural births are much cheaper for the community, since no costs are incurred for surgery and because his wife and child could leave the hospital usually faster. Recent data of the Institute for the Hospital Remuneration System that a natural birth ( depending on the province ) with 1477-1638 euros is paid. A caesarean section costs the health insurance 2554-2836 Euro.

Finally, many of the natural childbirth see proven to be right, as it has evolved over many millions of years by evolution.

Opponents of the request caesarean section, such as the German midwives associations criticize the emphasis on the alleged self-determination of women to the question request cesarean yes or no. You do not see the desire caesarean section as equivalent alternative. Rather, the increase was a social aberration, which derives from the fact that more and more of a view of the birth -enforcing as more or less risky medical, mechanical process. Midwives to advise pregnant women usually with a different fundamental view of things; they see the complication-free birth as a natural, non-medical process that have nothing to do with disease. The desire of pregnant women after a caesarean section was the result of fear of childbirth in general. This fear to be taken seriously, deal with it and overcome it, see midwives as part of their task.

An essential problem of rising caesarean section rate is that younger obstetricians other medical procedures for difficult births learn more and more rare. So it is required that in academic education the practical procedure is trained in different birth situations in scenarios and realistic models. All obstetricians should be regularly taught in training and further developments of the current state of knowledge and standard practice to be questioned.