Caesarean delivery on maternal request (CDMR), also called an elective caesarean section, is the conduct of a delivery via a caesarean section (CS, or c-section) not by medical necessity or indication but on request of the pregnant patient.

Over the last century, delivery by CS has become increasingly safer. The indications for delivery by CS therefore could become “softer”, and the move to perform CS on request can be viewed as an extension of this development. It has been estimated that possibly 4-18% of all CSs are done on maternal request; however, estimates are difficult to come by.

The movement for CDMR may have started in Brazil. The ethical view that a woman has the right to make decisions regarding her body has empowered women to make a choice regarding the method of her childbirth. Furthermore, with women living longer, concern about damage to the pelvic floor organs by vaginal delivery adds an additional dimension to the issue. Such damage could lead to a relaxation in the ligaments that hold the pelvic organs in place; urinary incontinence can become a consequence.

A meeting of experts sponsored by the NIH in March, 2006 attempted to address the medical issues and found "insuffient evidence to evaluate fully the benefits and risks" of CDMR versus vaginal delivery, and thus was not able to come to a consensus about the general advisability of a cesarean delivery by demand. The available evidence suggests certain differences as follows:

Proponents for CDMR on request will point out that it facilitates the birth process by performing it at a scheduled time under controlled circumstances, with typically less bleeding, and less risk of trauma to the baby. Furthermore, there is some evidence that urinary stress incontinence as a long-term result of damage to the pelvic floor is increased after vaginal birth. Opponents to the process feel that this is not natural, that the costs are higher, infection rates are higher, hospitalization longer, and rates for breastfeeding decrease. Also, once a CS has been done, subsequent deliveries will likely be also by CS, each time at a somewhat higher risk. Further, babies born after a vaginal delivery tend to be at a lower risk for the respiratory distress syndrome.

Studies that address maternal mortality or neonatal mortality show no significant differences.

There is no study to compare directly the risks and benefits of CDMR vs natural birth. The indirect evidence as reviewed by the NIH panel suggests "relatively similar degrees of risk from both pathways in women intending to limit their childbearing to one or two children."

Thus the issue of CS on maternal request remains controversial and will generate more discussions as further studies are needed to examine its benefits and risks.

Note

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British English spelling is "caesarean" and American English spelling is "cesarean".

References

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External links

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• Summary of 2006 NIH Report

Obstetrics | Surgical procedures