Caesarean delivery on maternal request

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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.[1]

The movement for CDMR may have started in Brazil.[2] 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.[3] 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. Women who have an extreme fear of childbirth, also called tokophobia, often choose elective c-sections.

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.[1] The available evidence suggests certain differences as follows:

Proponents for CDMR 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. [citation needed] 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. However, this is usually due to incorrect pushing (directed, with a woman lying on her back) and not from childbirth itself. When women are able to push in upright positions stress incontinence usually does not result. Opponents to ECS feel that it 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.[1]

Further, a new study shows that voluntary c-sections result in more baby deaths--much higher than previously believed--leaving vaginal birth the safest choice for women and their infants.4

[edit] References

  1. ^ a b c NIH (2006). "State-of-the-Science Conference Statement. Cesarean Delivery on Maternal Request". Obstet Gynecol 107: 1386-97, also [1].
  2. ^ Finger (2003). "Caesarean section rates skyrocket in Brazil. Many women are opting for caesareans in the belief that it is a practical solution.". Lancet 362: 628. PMID 12947949.
  3. ^ Minkoff (2004). "Ethical dimensions of elective primary cesarean delivery.". Obstet Gynecol 103: 387-92. PMID 15166864.

4. Bakalar (2006) "Voluntary c-sections Result in More Baby Deaths." The New York Times.

[edit] External links

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