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Der Kaiserschnitt – vielleicht der Geburtsmodus des 21. Jahrhunderts

Cesarean section – possibly the birth mode of the twenty-first century

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Zusammenfassung

Zum globalen Anstieg der Sectiorate tragen Faktoren aus mehreren Bereichen bei: Medizin, Demographie und Veränderungen der Arzt-Patientinnen-Beziehung. Der im Wesentlichen kulturelle, nichtbiologische Charakter dieser Faktoren erklärt, warum die Kampagnen zur Senkung der Sectiorate erfolglos bleiben mussten. Zur Nomenklatur wird vorgeschlagen, einen Kaiserschnitt dann als Sectio auf Wunsch der Schwangeren zu bezeichnen, wenn er nach unauffälliger Schwangerschaft mit eutrophem Kind in Schädellage nach der 38. Schwangerschaftswoche stattfindet. Zustand nach Sectio oder nach traumatisierender Geburt sollten als Indikationen anerkannt, der Begriff „tocophobia“ wegen seiner abwertenden, pathologisierenden Konnotationen nicht verwendet werden. Die Sectiofrequenz sollte keinen Qualitätsindikator für eine Abteilung oder ein nationales Gesundheitssystem darstellen. Nachdem die Spontangeburt zwar ein natürlicher, aber kein ungefährlicher Vorgang ist, sollte über die typischen Risken einer Spontangeburt vergleichend zur Sectio aufgeklärt werden. Die Sectio kann dann als Geburtsmodus des 21. Jahrhunderts bezeichnet werden, wenn der Patientenaufklärung große Bedeutung zugestanden wird. Die Gruppe von jungen Schwangeren mit Wunsch nach mehreren Kindern, bei denen vor allem Informationsmangel und Ängste vor Schmerzen zum Sectiowunsch führten, stellt eine Zielgruppe für eine intensive Aufklärung vor. Ferner ist auf eine Verringerung der Mehrlingsrate nach IvF hinzuarbeiten.

Abstract

Factors from many areas have contributed to the global increase in the rate of cesarean sections, such as medicine, demography and changes in the physician-patient relationship. The essentially cultural, non-biological character of these factors explains why the campaign to reduce the rate of cesarean sections cannot be successful. Suggestions for the nomenclature are that an elective cesarean section should be defined as such when it is carried following an uneventful pregnancy with the fetus in cephalic presentation and after 38 weeks of gestation. A condition following cesarean section or traumatic delivery should be recognized as indications and the term tocophobia should not be used due the deprecative, pathological connotations. The rate of cesarean sections should not be considered as an indicator for the quality of a department or of a national healthcare system. As a spontaneous delivery is a natural procedure but is not entirely without risk, the typical risks of a spontaneous delivery should be explained in comparison to a cesarean section. The cesarean section could be described as the birth mode of the twenty-first century when patient informed consent is allowed great importance. The group of young pregnant women with the desire to have more children who decided on a cesarean section due to lack of information and fear of pain, represents the target group for an intensive clarification. A further target is a reduction in the rate of multiple births following in vitro fertilization.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. M. Langer gibt an, dass kein Interessenkonflikt besteht.

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Correspondence to Univ.-Prof. Dr. M. Langer.

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Langer, M. Der Kaiserschnitt – vielleicht der Geburtsmodus des 21. Jahrhunderts. Gynäkologe 46, 715–721 (2013). https://doi.org/10.1007/s00129-013-3180-4

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Schlüsselwörter

  • Entbindung
  • Pränataldiagnostik
  • Selbstbestimmung
  • Arzt-Patienten-Beziehung
  • Maternale Morbidität

Keywords

  • Delivery
  • Prenatal diagnostics
  • Self-determination
  • Physician patient relationship
  • Maternal morbidity