Caesarean section (CS) is the most common surgical procedure in the world with around 40 millions CS every year in the world (1,2)

Yet, in most hospitals, it remains a standardised experience, identical for every woman. It has been designed to be commoditised, feasible by any obstetrician, anytime, with any team member available. I have personally done CS in France, in the UK, or in Syria during the war with very different teams. At these times, having a standardised surgical technique was life saving, as I did not have to worry about the competency or experience of the team around me. This standardisation of this procedure is reflected in the fact that patients say,: “I had a caesarean section”, not “I had this C section or that C section”.

The current CS technique that is taught in the UK, as described in the NICE guideline “Caesarean Birth” (NG192) is optimised to be able to be done in all situations, whether you have a fibroid, a cyst on the ovary, a low lying placenta, or anything else. A single-objective optimisation—such as universality—may compromise performance on competing endpoints, including bleeding and postoperative pain.

But in the era of personalised medicine, the way we deliver surgical birth must evolve.

The HOPE Section introduces a new, patient-centred approach to caesarean care—one that is tailored, evidence-based, and deeply respectful of each woman’s values, body, and recovery. We design a caesarean section pathway that is tailored to your particular need and optimises what matters to you most, whether it is pain or bleeding or fertility or recovery.

But this means building a team that has the capacity to perform a varied portfolio of surgical technique, anaesthetic protocol and postoperative protocols. It requires educating patients and supporting them to clarify their needs, preferences, and fears, thereby facilitating shared decision making that weighs the trade-offs between alternative techniques.

A one-size-fits-all model does not reflect the diversity of women’s needs, goals, or expectations. This approach is lacking behind at a time where personalisation should be the standard of care in every aspect of Medicine.

The HOPE Section (Holistic Operative Pathway for Excellence) is a structured, multidisciplinary approach to C-section care that supports:

• Shared decision-making based on detailed preoperative discussion

• A menu of surgical options tailored to individual priorities (e.g., minimising blood loss in case of anaemia, reducing pain, optimising future fertility, decreasing the risk of future ovarian cancer)

• Recovery pathways aligned with personal goals (e.g., early mobility, opioid-free pain control, enhanced bonding by providing capacity to carry baby earlier)

• Integration of emotional and environmental considerations into the birth experience

This is not a single technique, but a philosophy of care, grounded in evidence, using a portfolio of several techniques and personalised for each patient, grounded in:

• Education & Empowerment: Every woman deserves a full understanding of her surgical birth options.

• Autonomy & Consent: Informed choice is central to every stage of the pathway.

• Excellence: Care is grounded in best evidence and tailored by clinical judgement.

• Holism: The mother, the baby, the family unit, and their environment are all considered.

• Multidisciplinary Collaboration: Obstetricians, anaesthetists, midwives, nurses, and physiotherapists contribute to optimising outcomes.

By aligning surgical, anaesthetic, and recovery choices with each woman’s stated priorities, we replace one-size-fits-all with personalised excellence. Let us commit to making this the norm, so every caesarean reflects what matters most: the mother and her baby. So ask your healthcare provider about your options and advocate for a personalised approach to your caesarean