Desired cesarean section

from Wikipedia, the free encyclopedia

Desired caesarean section ( WKS , desired caesarean section , desired caesarean section , "elective caesarean section" ) is a term for a caesarean section that is not medically necessary, but is carried out solely at the request of the expectant mother.

In Germany, these are used to ensure reimbursement by the health insurance companies , e.g. B. declared as medically necessary interventions, so that it is no longer statistically reliable to determine whether it is a requested Caesarean section. There are studies that show that around two percent of caesarean sections in Germany are performed without a medical indication . The main reasons for the decision to have a caesarean section, which also include the desired caesarean sections, include the recommendation of the doctor or midwife (73%), the unfavorable situation of the child (41%) and fear for the child (39%).

statistics

In 2003, 175,341 women (25.5 percent) were delivered by caesarean section in Germany, in 2012 the figure was 208,254 (31.9 percent). Among the federal states, the highest proportion was observed in Hesse and the lowest in Saxony. The German federal government saw as reasons for the increasing caesarean section rate, among other things, a growing proportion of high-risk pregnancies among pregnant women and improved risk-benefit assessments in individual cases due to improved surgical and anesthetic techniques. A study commissioned by the Working Group on Women's Health in Medicine, Psychotherapy and Society (AKF eV) in 2012 produced “a largely homogeneous picture of the assessment of the causes of the high caesarean section rate” by midwives and doctors.

Among the cesarean section rates available for 2011 in twelve European countries, particularly high cesarean section rates were observed in Italy (37.7 percent) and Romania (36.3 percent), and particularly low rates in Finland and Sweden (16.2 percent each). In Germany, the caesarean section rate was 31.1 percent. In an international comparison, however, Germany was in the middle, while Turkey had one of the highest rates of Caesarean sections.

Different studies assume a desired kaiser cut rate of a maximum of two to three percent in Germany. A survey of around 4,200 mothers insured with the Barmer GEK in February 2012 showed that only two percent of those questioned expressed the wish for a caesarean section. Although women feel safer during childbirth through technology-intensive care, this does not result in the desire for a caesarean section.

Arguments from proponents of desired cesarean section

Proponents argue that natural births also entail health risks for mother and child and that women should have a say and veto in decisions whose health consequences may fundamentally influence their entire further life and that of the child. According to the Viennese gynecologist Wolfgang Grin, they see the desired cesarean section as an equivalent treatment alternative to “natural birth” and refer to the woman's right to self-determination . The decision for or against a medically unnecessary caesarean section should only be made by the mother after she has been informed about the advantages and disadvantages of midwives and doctors.

Avoiding the Health Risks of Natural Birth

  • In the case of the mother, injuries and tears in the pelvic floor muscles , the cervix , in the vagina , the labia and the sphincter muscles of the anus can occur during a natural birth . In many cases, these injuries are superficial and heal without consequences after a few weeks or months. Occasionally, however, persistent health problems such as urinary and fecal incontinence, persistent urge to urinate, loss of sexual sensitivity, lowering of the pelvic floor, lowering of the bladder , vaginal prolapse or uterine sagging result . These problems are significantly less common after caesarean sections .
  • With babies: no conjunctivitis due to infection in the birth canal, avoidance of pelvic problems, avoidance of shoulder dystocia

Missing individual risk scores

When giving birth vaginally, women can suffer injuries to the pelvic floor or the sphincter muscles , which permanently impair their quality of life and professional practice. There are specific risk factors for this, such as a heavy child or an elderly mother. In the professional world, the development of scores for individual risk assessment has been required for over 20 years, meanwhile there are also some scientific studies. Their use in Germany as part of prenatal care is not currently being considered.

Arguments from wish-c-section critics

Critics have argued that the caesarean section leads to temporary adaptation problems in the child. Adaptation problems are adaptation problems of the child that occur immediately after birth (postnatal). The physiological cause lies in the changeover of the circulatory system to lung breathing after birth. The clinical signs are decreased heart rate (bradycardia) and breathing disorders. Breathing disorders are not morphological or biochemical disorders or diseases of the lungs, but rather a lack of impulse to breathe. Such children sometimes need oxygen and breathing assistance. The whole thing usually takes no longer than a few minutes, but it can also make it necessary to move to a children's clinic. The problem also arises when the caesarean section is performed on the scheduled date without going into labor, as a study of 34,000 babies at the Danish University Hospital in Aarhus showed.

In a natural birth, these disorders occur significantly less often, since the children are prepared for the first breath by the release of stress hormones during the birth and the lungs are free of amniotic fluid.

Disadvantages for the mother are an increased mortality (about 1: 15,000 instead of 1: 50,000, but including the emergency caesarean sections , which reduces the value of this statistic ), a slightly increased risk of low placenta in subsequent pregnancies and a slightly increased risk of Infections related to the surgery. An additional risk is an increased risk of rupture of the uterus in the cut area during subsequent births. A rupture of the uterus in the old scar area can occur during labor due to labor and can be life-threatening due to undetected bleeding. However, this is a rare complication, the risk is 0.4%.

It is debated whether there is an increased child mortality. Here opinions differ from twice as high a mortality as in natural birth to the same mortality in caesarean sections as in natural birth.

Scientists from the Diabetes Research Group at the Institute for Diabetes Research at the Helmholtz Center in Munich under the direction of Anette-Gabriele Ziegler examined the statistical correlation between environmental factors and various diseases in 1,650 children from risk families in a long-term study. According to this, the risk for children of diabetic parents is twice as high, at 4.8 percent, of developing diabetes after a caesarean section up to the age of 12 than after a natural birth (2.2 percent). Study participants were followed for an average of 11 years from birth. The researchers see an explanation in the fact that delivery by caesarean section changes the composition of the child's intestinal flora and thus favors the development of autoimmunity, although the authors state that this correlation can also be attributed to the lack of homogeneity between the two groups. If the hypothesis is confirmed in more detailed studies, the caesarean section would be identified as the greatest known extra-genetic individual risk for diabetes-1, but it must always be seen in connection with other simultaneously occurring factors.

The formula used to be: once caesarean section - always caesarean section. In the meantime, this generalization has largely been abandoned. Nevertheless, the so-called "re-caesarean section" accounts for almost a quarter of all caesarean sections in Germany (23.6 percent in 2010) and thus ranks ahead of bad heartbeats (20.8 percent of all caesarean sections) and birth arrest (16.4 percent) Reason for a caesarean section. The assumption that a natural birth after a previous caesarean section is too dangerous is widespread. Although the risk of serious complications does increase after a caesarean section, these are very rare. In addition, renouncing the emotional birth experience and renouncing bonding are often cited as disadvantages.

Natural births - if they proceed without complications - can be cheaper for the community because there are no costs for an operation and because women and children usually leave the hospital faster. Data from the institute for the remuneration system in hospitals show that a natural birth (depending on the federal state) is remunerated with 1477 to 1638 euros. A caesarean section costs the health insurance between 2554 and 2836 euros. At the same time, there are voices on the part of the clinics and the medical profession that the flat-rate birth rate provided by the health insurance companies does not cover all of the actual costs incurred during a natural birth in compliance with valid quality standards.

Opponents of the desired caesarean section, such as the German midwifery associations, criticize the emphasis on the supposed right of women to self-determination when it comes to the question of the desired caesarean section yes or no . They do not see the desired cesarean section as an equivalent alternative. Rather, the increase is a societal undesirable development based on the fact that a view of birth as a more or less risky medical, mechanical process has prevailed. Midwives see the complication-free birth as a natural, non-medical process that initially has nothing to do with illness. The desire of pregnant women for a caesarean section is sometimes the result of fear of childbirth. This fear must be countered with appropriate information.

literature

  • The admissibility of the cesarean section on request. A medical, ethical and legal consideration, Nora Markus, dissertation, Faculty of Law University of Halle-Wittenberg 2005, Frankfurt am Main 2006, Verlag Peter Lang, ISBN 3-631-55068-5
  • It doesn't matter how we are born. Caesarean section risk . Michel Odent , Walter-Verlag, 2005, 177 pages, ISBN 978-3-530-42195-8
  • Caesarean section and cesarean section mothers . Brigitte R. Meissner, Meissner Verlag, 2003, 269 pages, ISBN 3-9522246-2-6
  • Caesarean section , Theresia M. de Jong and Gabriele Kemmler, 2003, ISBN 3-466-34461-1
  • Fact check caesarean section. Caesarean section births - development and regional distribution. Bertelsmann Foundation, 2012.
  • P.Kolip: Influences on the mode of delivery: Caesarean section versus spontaneous delivery, in: J.Böcken, B.Braun, U. Repschläger (Ed.): Gesundheitsmonitor 2012. Verlag Bertelsmann Stiftung. Gütersloh 2012. (pp. 182–204)

Broadcast reports

Web links

Individual evidence

  1. ↑ Desired caesarean section: birth according to the schedule . Spiegel Online , March 8, 2013; accessed on November 28, 2015
  2. ↑ P. Kolip: Factors influencing the mode of delivery : Caesarean section versus spontaneous delivery . In: J. Böcken, B. Braun, U. Repschläger (eds.): Health monitor 2012. Bertelsmann Stiftung publishing house. Gütersloh March 2012, p. 9
  3. ↑ Ulrike Lutz, Petra Kolip, with the collaboration of Gerd Glaeske , Corinna Schach and Christel Schicktanz: The GEK Caesarean Section Study . (PDF; 540 kB) Bremen 2006, p. 85
  4. ↑ a b German Bundestag (ed.): Answer of the federal government to the minor question from the MPs Cornelia Möhring, Birgit Wöllert, Sabine Zimmermann (Zwickau), other MPs and the DIE LINKE parliamentary group. - Printed matter 18/738 - Economic situation of midwives and obstetricians . No. 18/900 , March 21, 2014, ISSN  0722-8333 , p. 10, 11 ( bundestag.de [PDF]).
  5. ↑ https://www.arbeitskreis-frauengesundheit.de/wp-content/uploads/2015/05/KaiserschnittBroschuereEndfassung_01.pdf
  6. ↑ Page no longer available , search in web archives: Delivery by caesarean section - facts and debates in the transnational and transcultural context between Germany and Turkey@1@ 2Template: Dead Link / www.ash-berlin.eu
  7. ↑ Graphic to the previous itemization
  8. ↑ German Bundestag (ed.): Answer of the federal government to the small question of the MPs Birgit Wöllert, Sabine Zimmermann (Zwickau), Katja Kipping, other MPs and the parliamentary group DIE LINKE. - Printed matter 18/2249 - Development of the Caesarean section rate . tape 18 , no. 2365 , August 18, 2014, ISSN  0722-8333 , p. 8 ( bundestag.de [PDF]).
  9. ↑ P. Kolip: Factors influencing the mode of delivery : Caesarean section versus spontaneous delivery . In: J.Böcken, B.Braun, U. Repschläger (ed.): Health Monitor 2012. Bertelsmann Stiftung publishing house. Gütersloh 2012. (pp. 182-204).
  10. ↑ Fact check caesarean section. Caesarean section births - development and regional distribution . Bertelsmann Stiftung, 2012, p. 76 f.
  11. ↑ Caesarean section - desire or necessity , Wolfgang Grin; with a foreword by Univ. Prof. P. Husslein; Verlag Vabene 2004, 144 pages: ISBN 3-85167-160-0
  12. ↑ Volker Schumpelick, Werner Rath, Stefan Willis, Andree Faridi: Anal incontinence after vaginal birth: an argument in favor of the caesarean section on request? Dtsch Arztebl 99 (2002), A 42-48, online
  13. ^ University of Sydney - Probability of Pelvic Floor Damage
  14. ↑ GynDepesche: What does the levator ani muscle look like shortly after birth?
  15. ↑ Oonagh Keag, Jane Norman, Sarah J. floor: Long-term risks and benefits associated with cesarean delivery for mother, baby, and Subsequent pregnancies: Systematic review and meta-analysis. In: PLOS Medicine. Retrieved April 1, 2018 .
  16. ↑ Abdul H Sultan: Preserving the pelvic floor and perineum during childbirth - Elective caesarean section? In: BJOG An International Journal of Obstetrics & Gynaecology. Retrieved April 1, 2018 .
  17. ^ D Wilson, J Dornan, I Milsom, R. Freeman: UR-CHOICE: can we provide mothers-to-be with information about the risk of future pelvic floor dysfunction? In: Int Urogynecol Journal , PMID 24740445
  18. ↑ Karl C McPherson, Andrew D Beggs, Abdul H Sultan, Ranee Thakar: Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system? In: BMC Research Notes. Retrieved April 1, 2018 .
  19. ↑ Risk of caesarean section. Woe to go into labor ( Memento from December 19, 2007 in the Internet Archive ) sueddeutsche.de, December 18, 2007
  20. ↑ Caesarean section increases the risk of type 1 diabetes: results from the BABYDIAB study . (PDF) DZKF 9 / 10-2012. Main topic: gynecology
  21. ↑ U. Kraft: On the trail of diabetes. Origin of type 1 diabetes . In: Diabetes , No. 2, 2016, pp. 42-50
  22. ↑ Fact check caesarean section. Caesarean section births - development and regional distribution . Bertelsmann Stiftung, 2012, p. 55 ff.
  23. ↑ Fact check caesarean section. Caesarean section births - development and regional distribution . Bertelsmann Stiftung, 2012, p. 33.
  24. ^ Article in the Ärzteblatt
  25. ↑ Information brochure of the Swiss Midwives Association