Types of caesarean

A caesarean is an operation using an incision through your abdominal wall and uterus to deliver your baby.

A caesarean may be agreed in advance (an elective) or carried out as an emergency as a result of a change in the medical status of you or your baby. An elective caesarean can be suggested by either the mother or her obstetrician. In either case it is planned prior to the onset of labour. Bear in mind that in the press and on the web the term 'elective caesarean' is used in a number of different ways. For the purposes of this website we will use the definition above and this is the one used by most UK medical journals etc.

Classifications

The following classification is typically used by healthcare professionals when assessing the need for a caesarean. Knowing this classification can help you be more involved in the discussion if you find yourself in an emergency situation:

It is important to note that the term "failure to progress" alone is not a valid reason for a caesarean. If it is being suggested that you have a caesarean on this basis and you do not want to, ask for further clarification (with the above classification in mind).

Elective caesareans

The term elective caesarean refers to those occasions where a caesarean is conducted as a result of advanced planning and the mother or the obstetrician may suggest it. Throughout this website we refer to an elective caesarean in this way.

An elective caesarean, due to its non-emergency situation, is, comparatively, a very calm and positive experience. Your baby is not in distress and neither are you. According to the Nuffield Study mothers found that "theatre staff were reported as friendly; the woman was the centre of attention and her needs and feelings acknowledged. The environment (to the woman) seemed relaxed, there was an air of normality - several chatted to the anaesthetist through the operation or joked with him/ her. Sometimes it was such happy memories that made women consider a second elective caesarean section favourably." 56

It is worth noting that in the UK the use of the term may vary from one hospital to the next. Most UK medical journals use the definition above. The National Institute for Health and Clinical Excellence (NICE) refer to an elective caesarean as follows: "Planned CS [caesarean section] refers to a CS that is scheduled before the onset of labour for a specific clinical indication." 27 In some instances this definition includes those caesareans deemed "unnecessary" by medical professionals. On the internet it is not uncommon to find that the use of this term varies significantly, thereby effecting the interpretation of statistics being quoted.

If labour commences prior to an elective caesarean, the hospitals should still honour the arrangement to have a caesarean. According to Guy's and St Thomas' hospital in London, 1 in 10 women will go into labour before the date of their elective caesarean. They also state that "Vaginal delivery is safer for the mother, but an emergency caesarean section in labour has more risks than a planned elective one" 86.

The Nuffield Study found that some women spent a lot of time thinking about their birth options, in particular the elective route and summarised: "Underpinning almost every woman's account was the assertion that vaginal birth was normal and the 'best' way to have a baby. However, in women who had wanted a caesarean section this was always balanced by conflicting talk of how vaginal birth could go 'wrong'. Vaginal birth was positioned as something unpredictable where, especially with a first baby, no one could guarantee that events would follow any particular pattern. Women had been concerned that they could end up enduring many hours of painful labour only to need an emergency caesarean section. Thus elective caesarean section was often positioned as a more favourable option than risking labour that might end in an emergency. Caesarean section was presented as something involving an ordered process of events and, perhaps more significantly, under the control of the professionals…[and those] women who considered themselves 'at risk' often valued this aspect, sometimes conflating speed of delivery with ease." 56

Emergency caesareans

The term emergency caesarean refers to those situations where labour has started and a caesarean has become necessary but was not planned at the start of labour. An emergency caesarean, refers to an occasion when the baby needs to be delivered urgently for medical reasons and may occur prior to the onset of labour or during labour.

In an emergency situation there is a lot to be done, it has to be done quickly and may seem rather chaotic and frightening.

If you end up in an emergency situation, you are likely to fare better in mental and emotional recovery if you have been involved in the discussion leading up to the surgery and have prepared yourself for such a possibility during your pregnancy. 1 in 4 women will have a caesarean, emergency or elective, according to the current statistics.

The surgical procedure differs little from an elective caesarean. The setup is quicker and the following are likely to occur before the surgery commences:

In some cases it may prove necessary to have a general anaesthetic. In this instance the mother's experience is quite different in a number of respects, but the surgical side of the procedure does not change significantly.

Differences between elective and emergency caesareans

An elective caesarean, due to its planned nature, is inherently more satisfactory than an emergency caesarean in the following ways:

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