What is an elective cesarean section?

At the beginning of a pregnancy, the birth still seems far away. But at the latest in the last trimester of pregnancy, the thoughts of the pregnant woman increasingly revolve around the question of how and where the baby should be born. In the clinic or at home? Water birth or elective cesarean section?

Especially for parents expecting their first child, it is often difficult to imagine the birth. Although many birth stories circulate, especially on the internet, it can be hard to get a realistic idea of this event.

For many pregnant women, it is unusual to trust their own body and their ability to give birth. Especially with the first child, birth is a big unknown, there are no role models, and often only dramatic birth stories remain in memory.

Since medically dominated obstetrics often emphasize the risks, the planned birth via elective cesarean section may seem like the ideal solution. During the birth planning discussion with the midwife or when registering at the clinic, a planned cesarean section is often requested. For the decision about the type of birth, you should seek detailed advice to weigh all the pros and cons.

Cesarean section rates vary across Europe, ranging from under 20% in Northern Europe to 44% in Southern Europe: The WHO recommends a cesarean section rate of ten to 15 percent; beyond that, there are no positive effects on the health of the mother and child or on potential risks.

Since many children are born via cesarean section, it gives the impression that it is an uncomplicated birth method. You should know that a cesarean section, despite all the routine, is a major abdominal surgery: For the birthing person, there is an increased risk of bleeding and infections after birth, as well as an increased risk of thrombosis.

After a cesarean birth, recovery is often slower, and breastfeeding can be more challenging to start. For your baby, the transition to life "outside" is often harder than with a vaginal birth because the contractions as a precursor are missing. A cesarean baby is more likely to have breathing problems and so-called adjustment disorders in the first hours. Studies show a slightly increased risk for cesarean babies to develop allergies, asthma, or type 1 diabetes. For several years, experts have been researching whether the absence of the mother's vaginal microbiome has an impact on the baby.

A distinction is made between a planned cesarean section, the primary section, and an unplanned one, the secondary section. A planned cesarean section is necessary, for example, in cases of maternal illnesses such as gestational diabetes or high blood pressure.

If the placenta is located in front of the cervix (a so-called placenta previa) or the baby is lying transversely in the abdomen, a planned cesarean section is also performed. In the case of a breech position (the baby is head-up) or a twin birth, it depends on the individual circumstances of the mother and child and whether the obstetrics team at the respective clinic recommends a planned cesarean section.

A secondary, unplanned cesarean section is always necessary when risks for the mother and child arise during the course of a vaginal birth. These include, for example, a significantly slowed labor progression or poor heart tones of the baby.

There are often intense and emotional discussions among women and parents about the type of birth. Vaginal birth is frequently portrayed as the natural way, while cesarean section is seen as a second-class birth. Mothers who have given birth via cesarean section still often feel guilty and not like they have truly given birth.

For some time now, cesarean section has also been referred to as abdominal birth to emphasize that it is indeed a birth and not merely a surgical procedure.

If you wish for a planned cesarean section during your pregnancy, you should not have to justify it. However, in most clinics, it is customary to receive detailed counseling and be informed about the advantages and disadvantages. Some clinics additionally offer a conversation with a psychologist or require it to better understand the psychological background of your wish.

An elective cesarean section is a procedure without medical necessity. There are clinics that do not perform it for this reason. It is also not covered by health insurance. However, many obstetricians value the self-determination of pregnant women and want to enable them to choose their preferred birth method.

The medical guideline for cesarean section states that after a detailed conversation, presentation of all risks, and possible counseling by a psychologist, the woman's wish for a cesarean section should be granted.

Do you have the wish for an abdominal birth? Your feelings and thoughts are important. What is driving you? Are you afraid of pain or losing control? Have you perhaps experienced a traumatic event during a previous birth? Or are you worried about your body, your love life, or your child's health?

Speak openly with your midwife, your gynecologist, or a psychologist. They can listen to you, understand your reasons, and show you possible alternatives or support options. Often, multiple conversations are helpful to find out how the wish for a cesarean section arose and what support you need as a pregnant woman to make your decision.