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The rate of Caesarean section has increased in the past decades and both the professional and the unprofessional public are concerned about it. 21 % frequency of Caesarean section was recorded at national level, in the United States of America by the end of 1990ies, therefore a new governmental program was developed in order to reduce this rate to 15 %, however this could not be implemented and even the number of the operations has increased. (No decision on the necessity of an operation can be made from a desk.

Actually the question is how far it is reasonable to follow the prophylactic approach.) According to the data of 2003 the rate of Caesarean sections was 26,7 %, including elective (scheduled already for a given time) Caesarean sections increasing to 19,1 %. Instead of the „imagined” 15 % frequency of the Caesarean sections exceeded 30 % in the United States by 2007. The rate of Caesarean sections in the countries of the European Union is varying; it was 20,5 % on the average in 2000 and it increased to 23,6 % in 2004.

The international trend can be observed in our country, too; the national frequency was around 10 % in 1990, it has doubled by the beginning of the 2000ies and it was almost 30 % in 2006.

Dangerous operation? Caesarean section is an operation that can be performed safely now, but of course any intervention can be accompanied with non-desired cosequens. According to the statistics it is very rare, but can occur that the mother dies during the Caesarean section. In these cases mother’s death can be hardly attributed to the operation, because usually severe maternal diseases are in the background (a priori these make Caesarean section necessary) and not the intervention itself. According to the international statistics mother’s death among patients who have undergone Caesarean section was 3-7-fold higher than in case of vaginal deliveries in the second half of the past century, but in the first decade of the new millenary there is no difference in respect of the death rate of mothers with planned Caesarean section or spontaneous vaginal delivery. The most frequent life-threatening complication is bleeding, but this can be well controlled by experienced surgeons in well-equipped institutions. Surgical complication such like damaging or inflammation of other organs is relatively rare. Severe complications e.g. thrombosis, embolism are less frequent after vaginal delivery. However deterioration of the function of pelvic floor is much more frequent than after the abdominal operations. This can be proved with objective measurements by now. All these require philosophic approach of Caesarean section in addition to the professional aspects.

Fetal risk of Caesarean section is negligible;in fact the number of birth damages (e.g. arm, shoulder), neonatal sepsis, stroke and hypoxalnic effects of lack of oxygen is reduced.

Probability of Caesarean section is increasing by older age of the mother both in case of primaparas or multiparas; one of the reasons is that the arrival of the first child extends to the years of 30 and 40ies due to career and education concerns. Higher age and education, as well as, the related better capacities for enforcing the interests affect the frequency of Caesarean section as it is shown by the statistics.

The social demand of providing the possibility for the expectant women to ask performance of Caesarean section without medical indication has arisen in the past decade. There are countries where it is permitted; according to the American statistics the rate of Caesarean sections performed at the request of the mother reaches 4-18 % of total Caesarean sections. The most frequent reason on behalf of the women is fear of pains and of the delivery itself. In case of multiparas the unpleasant experience of earlier deliveries can be the main reason for this request. There is not available a reliable domestic study about the rate of women in Hungary, who wish to give birth by Caesarean section. Usually it can be said that about 6-10 % of the pregnants are afraid of delivery, fears are related to pain, to birth damages, to urgent need of Caesarean section, to the change in family life and they are more frequent in case of primiparas. The domestic Obstetrics and Gynecologic Professional College emphases in its resolution of 2008 that no Caesarean section may be performed without medical indication, only at the request of the mother. However fear from delivery and unfavourable previous adventures in the family or among the friends can give reason for Caesarean section with respect to the obstetric status (large fetus, primipara etc.)

The willingness to have a child has been reducing for years and the first child is born by even older mothers. With the development of prenatal care even the severe mother’s diseases are not contraindications to bearing pregnancy. The level of prenatal diagnostics has increased, the number of pregnancies conceived by means of IVF method has been rising from year to year and the rate of twin pregnancies is growing accordingly. Operations made on the uterine e.g. due to myoma or malformations is also contributing to the frequency of Caesarean sections.

Expectation of the society from „modern” obstetrics is many fold, the main point is safety, possibly painless, simple and therefore Caesarean section is getting more and more accepted (and expected) „natural” way of giving birth. The public opinion accepts only success stories of 100 % (maximum expectations) and in case of complications the possibility of legal action is applied. In parallel there is the need for natural delivery,- that is extremity brings extremity,- back to the process of natural delivery, insisting on spontaneous vaginal delivery can also be experienced in addition to the Caesarean sections ordered by the patients. Everybody can decide on her own how she would like to deliver the baby and the ideas have to be agreed upon with the selected obstetrician. We respect the „delivery plans” with observation of the professional rules and within the given limits, but we can undertake a spontaneous delivery only in case the mother accepts that in case of a trouble Caesarean section must not be delayed!

At the same time we also respect if the mother wishes to get Caesarean section, but we can comply with this request only in case a detailed discussion is performed before, in course of which we can know the reason and justification of this wish and we can give information and explanation as to the benefits and the disadvantages of the Caesarean section in case of the pregnancy in question.

 

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