Editor—Dr Foster shows its ignorance of obstetrics in the article on social class and elective caesareans in the NHS.1 The authors imply that an “elective” caesarean section is performed solely at the request of the pregnant woman.
Traditionally an elective caesarean section is one carried out in the absence of labour. Many caesarean sections are performed to save the life of the woman and her infant—for example, because of severe pre-eclampsia or placenta praevia. Because they are carried out in the absence of labour they are often labelled “elective” in case notes. Women who have had a previous caesarean section after a long labour may wish to avoid the uncertain hazards of another labour and prefer to have an elective caesarean section. Very few women actually have a caesarean section performed solely at their request. In a recent survey of caesarean section 31 out of 3150 (1%) elective caesarean sections were performed solely at the request of the woman.2
Dr Foster shows only a weak relation between elective caesarean section and social deprivation but also an overwhelming relation between elective caesarean section and maternal age. It is the relation with maternal age that deserves further study. The authors could have made this important point in their paper; instead they have made an irrelevant one, by focusing on social deprivation.
Incidentally, the slogan “too proletarian for a caesarean” is cheap and offensive.
Competing interests: None declared.
References
- 1.Jarman, B, Aylin P, Bottle A. Social class and elective caesareans in the English NHS. BMJ 2004;328: 1399. (12 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wilkinson C, McIlwaine G, Boulton-Jones C, Cole S. Is a rising caesarean section rate inevitable? Br J Obstet Gynaecol 1998;105: 45-52. [DOI] [PubMed] [Google Scholar]