First Do No Harm: Addressing Respiratory Morbidity in the Newborn and Child Following Elective Caesarean Section Before 39 Weeks' Gestation (Scientific Letters) (Clinical Report‪)‬

To the Editor: Globally, caesarean section (CS) rates are increasing and vary between 18% and 31%, (1,2) but between 65% and 82% in some countries with private health care. (3,4) A CS performed for the right indication is in the best interest of the mother and/or baby. However, the indications for an elective CS at or near term remain controversial and vary widely. CS on request before 39 weeks' gestation and/or those performed for physician convenience or after incorrect interpretation of dates are of special interest. These elective CS criteria are unlikely to be in the best interests of the unborn child, mother, or family if performed too early. The interplay between a maternal request based on patient autonomy, (consumer) choice or convenience and physician threshold for choosing it before the due date remains a concern. Our experience is that these 'reasons' are rarely accurately recorded in the clinical notes, which often reflect unconvincing medical reason(s) for performing early CS. However, one cannot ignore the trend that an elective CS following a maternal request is regarded as a valid option in some developed countries and is often the major factor influencing the mode of delivery, (5-7) including a belief that its risks for healthy women are so low that CS is a reasonable elective childbirth option. (8) To determine the respiratory morbidity related to CS, we reviewed our own experience with infants of a gestation of 37 weeks, who required admission to a private neonatal intensive care (NIC) unit over a 6-year period. We then extrapolated our own and other results to create a scenario relevant to South Africa.