Not elective OR emergency...Advance Warning CS??

[izzie255]

Is anyone else less-than-impressed by the terms used for C-sections?? I was gobsmacked to find out that the arrival of DD counted as elective cos I knew a few days in advance it had to be a C-section (or she wouldn't have made it). There was nothing 'elective' about it!

Whenever people ask if she was an emergency CS I say 'no, she was an Advance Warning CS' :-P I think we really need to chance the language around it...

What's wrong with "electing" to have a C-section for health reasons? The wording only needs to change if you have a problem with it. Elective just means planned doesn't it. So I guess you could say planned C-section? But really what's the problem. If you're afraid people are going to judge you that's their problem.

There is a word, it is 'expedited'. Bear in mind Im a general surgeon not an obstetrician, but I'm sure the principle is the same. Certainly in general surgery there are actually four categories:

1. Emergency - this is equivalent of a 'crash' section, i.e. All hands on deck, running down the corridors etc.
2. Urgent - needs to be done within the day or so, but time to get things sorted and wait for you to call relatives, get changed for theatre etc.
3. Expedited - not so urgent you necessarily need to be in hospital whilst waiting, but equally not planned weeks in advance, sounds like this is your category. Decided that it needs to be a section, but not a lot of notice.
4. Elective - booked in well in advance.

Most people categorise 1&2 together as 'emergency' and 3&4 as 'elective', just to make it easier.

So, you are right.

Elective means 'preferred choice' to me. I had lots of elective module options at University.

I would very strongly prefer something like 'Scheduled C-section'. Elective CS are often for strong medical reasons which makes them far from small preference options. Scheduled or Planned would be better umbrella terms for non-emergency CS.

Maternal Request ELCS is a term used where women have an ELCS for mental health reasons. Again there is often not much maternal request about it, more trying to stop being traumatised or making mental health issue worse.

There are lots and lots of terms surrounding childbirth that are in much need of a review.

Failure to progress and Poor maternal effort are another two that spring to mind immediately.

In terms of an Elective CS it is at least comparable to other scheduled surgery where people may have little choice in the matter, but it is planned rather than carried out in circumstances where staff have no advance preparation for it.

Wildfire - that's helpful thank you. I had a c-section after a failed induction on the advice of the consultant but by that stage it was what I wanted too. They definitely wouldn't have let me leave the hospital and I had the c-section at lunchtime after agreeing to it in the morning. But the actual experience was calm so certainly not in the 'running down the corridor' category. I've never really known if it counted as an emergency or not.

Does it really matter?

I find with c-sections that anything less than a crash/emergency with minutes to live, is somehow 'looked down upon' by others.

Personally I don't really care- I had an ELCS for maternal request, not for metal health reasons, but purely because it's what I wanted my preferred 'mode of delivery' (I hate that term!).

I've got friends who feel almost embarrassed at their c-sections and one who just 'embellishes' the story, saying it was an emergency etc etc when in reality she knew at least a few days or so in advance.
She always says that it makes her feel ashamed she had an 'elective' CS, as if the choice was purely all hers.

My second one stated 'maternal request ' even though it was a failed vbac with failure to progress and I had refused/declined further induction type intervention.

I have seen what the op referred to described as unplanned CS before which sounds a little more accurate IMHO. eg when an elective is brought forward due to a concern.

The language around birth is generally shitty though. It isn't just sections. Failure to progress? Maternal effort?

I think the term elective does imply a choice in the matter to most people. My 1st was going to be elective as I had full placenta praevia, so a vaginal birth would've been impossible. It actually ended up as a cat 1 emergency in the end.
This time I think I will actually be electing, as in it's what I would rather do having weighed up risks / benefits. A very different situation to my 1st though.

I cared what people thought (and had some shitty comments) immediately after the birth but now time has passed I don't really care either!

Does it actually matter?

How the baby comes out has no reflection on what kind of parent you are or will be.

Just tell people to mind their own business!

I had eclampsia (full seizures) with DC1 and was a category 1 (life threatening) EMCS under a GA

DC2 I developed pre-eclampsia and had a C-section - it would have been deemed as elective as I was booked in 5 days before, despite the fact I had no choice.

I am booked for an ELCS under a GA with DC3 in three weeks - again, nothing elective about it, there is no other choice.

But I don't give a flying horse shit who thinks it is elective or not.

People give it the old "oh too posh to push"

I just respond with "Yeah you know me, posh posh posh"

Thing is, elective really doesn't mean 'by choice' it means planned. It has nothing to do with whether you have asked for it or not and just means booked in in advance. Thats the trouble with medical terminology, people use words incorrectly because of their own experiences, which leads to incorrect assumptions about others, like in the example above.

(Don't get me started on people who use the word 'chronic' to mean serious or severe, it doesn't, it means 'long-standing'). And breathe.

If we stopped judging people, the terms wouldn't matter. It shouldn't matter if it's a choice 'for health reasons' or not. Or planned. Or any other term.

I'm not sure that that's quite true. Yes, it would help. But people have legitimate preferences about giving birth, and to be told that they 'elected' something a world away from what they would have liked can still sting. A bit like if someone was told they had 'elected' to ff when they were desperate to bf but couldn't because of medication or something. Even without judgment, we can feel disappointed when things don't pan out to our hopes, and language can twist the knife.

A cousin was due a planned CS but went into labour, so it became an 'Emergency' CS. But although the timing had to change, it had still been planned, so that to my mind made the terminology of EMCS a bit silly.

I wouldn't get too hung up on the terms used. It doesn't matter, really.

My notes say my first baby was born by 'elective' section, although the section happened with 6 hours notice after a failed induction and wasn't exactly a choice, more a 'baby needs to come out' decision made by the doctors.

My second baby was born by 'emergency' section at 37 weeks, which all sounds very dramatic, but I had 24 hours notice and it was a very serene experience.

There are so many different ways birth can go, I guess they can't have exact descriptions for every turn of events.

Penguin it's only really applied to birth though, an expectation or label for the reason behind the medical procedure (rather than just describing the procedure). If I have a cancer diagnosis where I'm oferred meds/therapy or surgery, and I choose surgery, no one bothers to call that elective surgery (or would ever expect or ask for an explanation). It's only because we judge each other that the terms are used re: birth.

That's not true Sparky. Any operation/medical procedure which is not done as an emergency is called 'elective' as it just means 'planned'.

Its a medical term that is entirely accurate. Suggesting we change medical terminology so that you feel a little more comfortable is bizarre. What difference does it make to anyone? Why would anyone, including you, care if your section was planned a month, a week, a day or a minute ahead, or that you had one at all?