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Cesarean delivery on maternal request

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

INTRODUCTION

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 a standard medical/obstetrical indication for avoiding vaginal birth. While some women are highly critical of the medicalization of childbirth, others strongly seek to avoid a natural childbirth experience and are reassured by safety of contemporary cesarean delivery.

This topic will discuss issues specifically related to cesarean delivery on maternal request. General issues regarding cesarean delivery, such patient preparation, technique, post-operative care, and complications are reviewed separately. (See "Cesarean delivery: Preoperative planning and patient preparation" and "Cesarean delivery: Surgical technique" and "Cesarean delivery: Postoperative issues" and "Anesthesia for cesarean delivery", section on 'Post-cesarean delivery analgesia'.)

OVERVIEW

The Agency for Healthcare Research and Quality (AHRQ) has published a detailed report on cesarean delivery on maternal request [1]. A synopsis of their findings, as well as subsequently published data, are provided below. These data are limited because no randomized trials on cesarean delivery for nonmedical/nonobstetrical reasons have been performed [2]. Thus, conclusions about the risks and benefits of cesarean delivery on maternal request are not based upon high-quality evidence. Available observational studies have serious methodological issues or provide indirect evidence because the cesareans in randomized trials were performed for breech presentation [3].

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.

Providing women with the best available information about pertinent childbirth issues and appropriate support may alleviate some of their concerns about attempted vaginal birth. The motivation for cesarean delivery should be determined and addressed. Every effort should be made to ensure that this is truly the desire of the patient and not a result of undue pressure from family members. Concerns about pain may be addressed by providing detailed information about obstetrical analgesia and anesthesia, as well as consultation with an anesthesiologist. Fear and anxiety stemming from personal trauma, previous childbirth experiences, or the childbirth experiences of friends and family should also be addressed. Tocophobia, which can be defined subjectively as severe anxiety or fear of pregnancy and childbirth, appears to be relatively common [4].

                              

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Literature review current through: Jul 2017. | This topic last updated: Jul 24, 2017.
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