A Clinical Crossroads review article in the May 8 issue of JAMAdiscusses the potential benefits and risks for pregnant women who request cesarean delivery without an indication of need rather than proceeding with a plan for vaginal delivery.
Jeffrey Ecker, M.D., from Massachusetts General Hospital, Boston, is the author of the article that examines this issue of cesarean delivery on maternal request (CDMR). Dr. Ecker writes the term “refers to cesarean delivery performed without maternal or fetal indication; i.e., with no expectation of improving the physical health of the mother or neonate.” Dr. Ecker notes that available data indicate that CDMR occurs in less than three percent of all deliveries in the United States.
“Reasons for considering CDMR include fear of specific elements of labor and concern for fetal or maternal morbidities attributable to vaginal delivery,” Dr. Ecker writes. “Compared with a plan for vaginal delivery, CDMR may be associated with lower rates of hemorrhage, maternal incontinence, and rate but serious neonatal outcomes. However, CDMR is associated with a higher risk of neonatal respiratory morbidity.” And Dr. Ecker writes that repeated caesarean deliveries have higher rates of operative complications and placental abnormalities.
The article concludes: “There is no immediate expectation for CDMR to reduce the health risks of mothers or infants. Accordingly, counseling and decisions regarding CDMR should be made after considering a woman’s full reproductive plans.”
(JAMA. 2013; 309(18):1930-1936)