Focusing on Caesarean section – subjective indications for abdominal delivery

Caesarean section as a method to end pregnancy which excludes spontaneous labour or labour through natural passages, was used as early as in ancient times. The first C-sections were performed after the pregnant woman’s death; those carried out 200-300 years ago were associated with high mortality rates, and it was only after the removal of the uterine body after the baby was extracted that the mortality rate stared to fall. Development of surgical techniques, and advances in anaesthesiology and antibiotic therapy over the past dozen years have made the procedure relatively safe. However, there has been an ongoing discussion whether performing Caesarean section without prior clear medical indications but only upon request of the pregnant woman/woman in labour is justified and should be respected. According to the WHO recom-mendations, the proportion of Caesarean sections should not exceed 10-15%. Yet both in Poland and abroad, the number of sections has risen significantly [1]. In Poland is it estimated that the rate is 25-30%, and in private clinics it is said to reach 40-50%. Since there are no legal regulations relating to Caesarean section upon the parturient’s request in Poland, subjective indications will still be regulated by medical indications. To some extent it is a justifiable security measure of obstetricians against a possible lawsuit, where the most frequently asked questions include: Why was a Caesarean section not performed? or Why was it done so late? On the other hand, court proceedings also concern com-plications after Caesarean section, and performing unjustified surgery (upon request) leads to a problematic situation [1–4]. Therefore, we should consider the motives of those pregnant women who postulate avoiding the delivery of their baby through natural passages, thus putting themselves under the risk of health complications and making the obstetrician face ethical and legal dilemmas.