What's the definition of "elective" C section? - Mothering Forums
Birth and Beyond > What's the definition of "elective" C section?
Tiacsophno's Avatar Tiacsophno 10:28 AM 05-19-2004
I'm starting to get confused, because I've seen this term used in many different contexts, and I'm beginning to wonder if it simply depends on the user's opinion about what constitutes "medical necessity"? Or maybe who is 'electing' the option (mother or doctor)?

So, what is the standard definition of 'elective' C-section? A c/sec that was not medically necessary? A c/sec 'elected' as one option available to the mother/provider, regardless of the real or perceived medical risks of each procedure offered? Any c-section that is not an emergency/unplanned c/sec? Is a scheduled c/sec due to breech considered 'elective'?

TIA, I just want to use the term correctly.

doctorjen's Avatar doctorjen 12:11 PM 05-19-2004
I usually use the term to mean both a c-section that is one option, even if the other options are not recommended, and a c-section that is not an emergency. So a c-section for breech presentation would be an elective c-section, and a repeat scheduled c-section is an elective repeat cesarean. The term as I use it medically is not meant to suggest that the cesarean isn't necessary, or preferable. A cesarean done under emergency conditions is not elective.
A cesarean done simply because the woman wants it, with no medical indication is now being called "patient choice cesarean."
copslass's Avatar copslass 01:46 PM 05-19-2004
:Puke :Puke :Puke
stafl's Avatar stafl 02:03 PM 05-19-2004
"elective" means there is a choice in the matter.
IMO any c/section that is scheduled ahead of time is "elective" because the option was always there to not schedule it.
I don't think necessity is an issue, some elective c/sections can surely be necessary in certain situations.
Greaseball's Avatar Greaseball 02:23 PM 05-19-2004
I think elective means not medically necessary. Of course, what is medically necessary is open to interpretation...if you ask me, it's placenta previa/abruptio, transverse baby when labor starts, pre-eclampsia, fetal distress, bandl's ring. Maybe there are some I'm not thinking of.

But other "medically necessary" sections are not medically necessary for everyone, such as footling breeches, triplets, unusually shaped uterus, and genital herpes.

I think if it's scheduled, it's elective. No one knows for sure that a transverse baby won't turn very late.
Kelly71's Avatar Kelly71 05:37 PM 05-19-2004
Quote:
Originally Posted by copslass
:Puke :Puke :Puke

cottonwood's Avatar cottonwood 05:56 PM 05-19-2004
I've always defined it as a cesarean that is perceived by the patient and doctor to not be medically necessary. In other words, if the doctor and patient believe there is no medical indication for it but do it anyway. For instance, people saying things like, "oh, I just want to be able to choose the baby's birth day," or "I don't want to go through the pain and hassle of vaginal birth," etc. But I wouldn't call it elective if the doctors and/or patient really believed that there was a medical indication for it, even if it was debatable.
Kari_mom's Avatar Kari_mom 09:12 PM 05-19-2004
We discussed this at my recent c-sec. My midwife, ob and anestiologist (how do you spell that word!) all follow this definition given by drjen:

Quote:
I usually use the term to mean both a c-section that is one option, even if the other options are not recommended, and a c-section that is not an emergency. So a c-section for breech presentation would be an elective c-section, and a repeat scheduled c-section is an elective repeat cesarean. The term as I use it medically is not meant to suggest that the cesarean isn't necessary, or preferable. A cesarean done under emergency conditions is not elective.

kimberlylibby's Avatar kimberlylibby 12:54 PM 05-20-2004
Hmm, interesting. I thought of it as being a NOT medically necessary c/s.

According to those standards above, my repeat c/s will be "elective" yet it is medically necessary.. well, perhaps not medically necessary, but seeing as how no midwives will accept me as a patient and all of the midwives said a c/s would be the smartest thing in my position.... I guess it *is* medically necessary... although I have no doubt that i could vaginally deliver this child...

Kimberly
Greaseball's Avatar Greaseball 01:01 PM 05-20-2004
It sounds like it's necessary by force only - no one will attend a VBAC, or at least not one for you, so they are forcing you to pick the repeat c/s or to stay home and do a uc. They didn't give you a choice, assuming you are not comfortable with the uc.
kimberlylibby's Avatar kimberlylibby 01:13 PM 05-20-2004
Exactly Linda. And since I had eclampsia/HELLP/placental abruption..... well, obvously, I'm a little leary of UC.

It's sad though, because this pregnancy has been SO healing for me and I've learned to trust my body again.... and it really breaks my heart that I will not be able to vaginally deliver because I can't find anyone to "let" me do it...

But at the same time, I'm not comfortable with UC because of my previous pregnancy experience...

Kimberly
stafl's Avatar stafl 01:24 PM 05-20-2004
(((((Kimberly)))))) it is breaking my heart, too! I wish there were something I could do for you. If you ever need anything, just let me know.
tinyshoes's Avatar tinyshoes 07:12 PM 05-20-2004
Well, mamas, we get to use the adjective 'elective', 'cause we're talkin' OR talk...here's some info on the Surgical Suite lingo:

from University of Maryland Medicine

Quote:
What are the different types of surgery? Depending on the diagnosis, a patient has several surgery options:

Optional or Elective Surgery - A procedure you choose to have, which may not necessarily be essential to continue a good quality of life. An example would be to have an unsightly mole or wart removed.

Required Surgery y - A procedure which needs to be done to ensure quality of life in the future. An example would be having kidney stones removed if other forms of medication and treatments are not working. Required surgery, unlike emergency surgery, does not necessarily have to be done immediately.

Urgent or Emergency Surgery - This type of surgery is done in reaction to an urgent medical condition, such as acute appendicitis.
So...a breech presentation might be concidered by an OB to be required surgery, when a midwife might concider a breech presentation to be a less common presentation than a vertex presenation.

This also clears up the concept "emergency c-section" that I have been confused about--when an OB tells a woman she could have a c-sec now, or she can "labor a little longer", but if she were to choose that option, and should the fetus show distress, well, then they'd have to do an emergency c-section.
OnTheFence's Avatar OnTheFence 08:45 PM 05-20-2004
Well by these definitions.

I had an emergency csection and then a required one.
And I can just see the faces of others if I started saying I needed a required csection. :
its_our_family's Avatar its_our_family 11:07 AM 05-22-2004
Yes... puking in this thread REALLY helps the discussion. Heaven forbid we use terms CORRECTLY and also helps us EDUCATE..sheesh.

I don't necessarily consider a repeat an elective (especially if you can't find anyone to help you otherwise). But in other ways I do consider it elective.

I think an elective is one that is chosen for superficial un-necessary reasons.
copslass's Avatar copslass 11:54 AM 05-22-2004
I was told by the ob that my baby and I would die of I ever labored again.

Yet that repeat, performed after labor began, is referred to in my medical records as an "elective repeat ceserean section."
Raven's Avatar Raven 04:08 PM 05-22-2004
I consider elective to mean chosen. Therefore I use the term "elective c/s" in the context where the c/s was CHOSEN for non medical reasons. As in, "I want this baby out on X day because I have a manicure appointment I dont want to miss..."

ETA - and yes I did mean to offend mothers who have had elective c/s for the reson stated above...
doctorjen's Avatar doctorjen 06:51 PM 05-22-2004
Generally, in hospitals (where the majority of surgeries are performed anyway) the word "elective" does not mean anything about the necessity of surgery, but rather the timing of surgery. If you have a hernia, you would see your surgeon and be scheduled for an elective hernia repair. If, while you were waiting to be scheduled, the hernia contents became strangulated and blood supply was subsequently cut off to a portion of bowel and you were in danger of overwhelming infection and possibly death and you came to the emergency room because of the pain, you would be taken to the operating room for an emergency hernia repair. Both the elective hernia repair and the emergency hernia repair are pretty necessary surgeries, just the timing is different.
When I write "elective repeat cesarean section" in the chart, I am not meaning to imply any judgement of necessity, only that due to the circumstances, we are able to pick a day, and do the surgery under calm circumstances on a well prepared mother. I think most docs use the term the same way I do.
thyme's Avatar thyme 07:28 PM 05-22-2004
Quote:
Originally Posted by doctorjen
Generally, in hospitals (where the majority of surgeries are performed anyway) the word "elective" does not mean anything about the necessity of surgery, but rather the timing of surgery. ......

When I write "elective repeat cesarean section" in the chart, I am not meaning to imply any judgement of necessity, only that due to the circumstances, we are able to pick a day, and do the surgery under calm circumstances on a well prepared mother. I think most docs use the term the same way I do.
This is my understanding of how the term is meant to be used, as well.
pugmadmama's Avatar pugmadmama 08:46 PM 05-22-2004
I don't understand the pukey smilies in this thread. Anyway...

My understanding of "elective" is the same as doctorjens. But I think the word "elective" has been politicized in regards to this issue.

It's like the term "missed abortion." I was surprised to read that in my chart in regards to my miscarriage, but apparently that's the correct medical term. Again, "abortion" has become so politicized that it's hard to remember it has a non-political meaning.
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