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Cesarean delivery on maternal request

Errol R Norwitz, MD, PhD, MBA
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


Cesarean delivery on maternal request (or "on demand") refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of standard medical/obstetrical indications for avoiding vaginal birth. A woman’s right to be actively involved in choosing the route of her delivery is now widely accepted by clinicians and patients [1-3]. In a well-informed patient, performing a cesarean delivery on maternal request is considered medically and ethically acceptable; in-depth reviews of the ethical issues are available elsewhere [1,2,4-9]. However, obstetricians are not obliged ethically or professionally to perform these procedures. Early referral to another healthcare practitioner is appropriate in such cases [1].


Estimates of the prevalence of cesarean delivery on maternal request range from 1 to 18 percent of all cesarean deliveries worldwide, and <1 to 3 percent of all cesarean deliveries in the United States [9-12]. These are crude estimates since birth certificates and discharge codes usually do not indicate whether a cesarean was performed at maternal request. The prevalence of the procedure appears to be increasing and correlated with increasing affluence [13,14].

Surveys of obstetricians, urogynecologists, and colorectal surgeons have reported a preference for cesarean by request for themselves and their family members [15,16].


The Agency for Healthcare Research and Quality (AHRQ) has published a detailed report on Cesarean Delivery on Maternal Request [17]. A synopsis of their findings, as well as subsequently published data, is provided below. These data are limited because no randomized trials on cesarean delivery for nonmedical reasons have been performed [18]. Thus, conclusions about the risks and benefits of cesarean delivery on maternal request are not based upon high-quality evidence. Available studies have serious methodological issues or provide indirect evidence because the cesareans were performed for breech presentation [19].

As with any medical procedure, the risks and benefits of cesarean delivery on maternal request need to be balanced with the risks and benefits of a planned vaginal delivery. Patient-specific issues that can affect the choice of delivery route include comorbid medical conditions, body mass index, future reproductive plans, prior childbirth experiences, outcome of previous surgical procedures, and the woman's personal philosophy about childbirth.


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Literature review current through: Sep 2016. | This topic last updated: Apr 4, 2016.
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