cesarean delivery

Caesarean delivery on maternal request

Caesarean delivery on maternal request (CDMR), is medically unnecessary caesarean section, where the the conduct of a childbirth via a caesarean section (CS, or c-section) is dictated by the pregnant patient.

Background

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. Until recently an elective caesarean section was done on the basis of some medical grounds; the CDMR situation, however, makes the mother's preference the determining factor for the delivery mode.

Many women are opting for cesareans in the belief that it is a practical solution. 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.

Prevalence

The movement for CDMR may have started in Brazil. It has been estimated that possibly 4-18% of all CSs are done on maternal request; however, estimates are difficult to come by. The global nature of the CDMR phenomenon was underlined by a study that showed that in southeast China about 20% of women chose this mode of delivery.

Controversy

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 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 CS 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 infant respiratory distress syndrome.

Subsequent to the NIH report a large review from the USA of almost 6 million births was published that suggested that neonatal mortality is significantly higher (1.77 vs. 0.62 per 1,000 live births) in babies born by CS. The authors propose that the compression of the fetal lungs during the birthing process may be one of the factors that is beneficial for subsequent survival; this effect is missing when the baby is delivered by CS. A study published in the February 13, 2007 issue of the Canadian Medical Association Journal found that women that have "planned" cesareans had an overall rate of severe complications more than three times that of women that planned vaginal deliveries.

References

External links

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