Elective cesarean section

Planned Cesarean Section - Overview

A Cesarean section, commonly known as a C-section, is a surgical procedure in which the baby is delivered through an incision in the abdomen and uterus. In Israel, approximately 20% of births are performed by C-section, with most of them being urgent procedures conducted when complications arise during spontaneous vaginal birth, such as suspected fetal distress or lack of progress.

However, there are cases where a planned or elective C-section is recommended. This decision is typically made by medical professionals when a vaginal birth poses a reduced risk to the mother or the baby. Common reasons for planned C-sections include previous C-sections, unfavorable fetal presentations (e.g., breech), previous severe perineal tear during vaginal delivery, placental abruption, and other rare indications. In some cases, the decision for a planned C-section may be based on the woman's personal choice, even without a medical indication.

At Shaare Zedek Medical Center, which handles approximately 22,000 births annually, including 6,000 at the Bikur Holim campus, the rate of C-sections is relatively low, accounting for only around 12% of births. The hospital aims to support vaginal births whenever possible, including allowing women with a history of previous C-sections to attempt a vaginal birth with high success rates.

For planned C-sections, the surgery is scheduled for weeks 38-39 of pregnancy, when optimal fetal maturity is expected. However, in certain situations where there is an increased risk to the mother or the baby, or to avoid the risk of spontaneous labor, an earlier termination of pregnancy may be necessary.

Planned C-sections at Shaare Zedek are typically performed on designated surgery days, with two days per week (Monday and Wednesday) specifically allocated for women who have had two or more previous C-sections or require a C-section for other reasons. The admission process occurs on the Sunday of the same week as the scheduled surgery.

Most planned C-sections are performed under spinal regional anesthesia (similar to epidural anesthesia), providing effective pain relief during and after the operation while allowing for a quick recovery for both the mother and the baby. The hospital strives to implement a friendly C-section approach, which includes measures like a transparent plastic screen through which the mother can witness the baby's emergence, a sterile sleeve that enables early contact with the baby, and promoting skin-to-skin contact and breastfeeding whenever possible.

To register for a planned C-section, the woman must submit a referral letter from a treating gynecologist at a health fund or other healthcare setting, along with relevant documents such as ultrasound examinations and medical summaries. Following the registration process, the woman will receive a date for admission to the hospital's pre-operative clinic, which takes place on Sundays. During this clinic, the woman will undergo consultations with a gynecologist, an anesthesiologist, and a midwife, as well as necessary examinations and tests. The day of surgery will be determined and communicated to the woman in the afternoon of the admission day.

Throughout the process, it is important for the woman and her support person to be well-prepared, ensuring they have adequate food, drinks, and other necessary items. The hospital staff is committed to providing support and assistance throughout the birth journey, and they are available to address any concerns or questions.

Women who need further evaluation regarding the mode of delivery can contact the obstetrics emergency department or the prenatal anesthesia consultation clinic (to make an appointment at the clinic - 02-6555999) from Sunday to Thursday between 08:00 and 14:00. Must arrive with a suitable commitment letter from Kupat Holim

Shaare Zedek Medical Center wishes all expecting mothers a smooth and safe birth, and they are ready to assist with any needs along the way.