Caesarean delivery on maternal request (CDMR), is a form of an elective caesarean section, where the the conduct of a delivery via a caesarean section (CS, or c-section) is dictated not by medical necessity or obstetrical indication but specifically the request of the pregnant patient.^[1] Elective caesarean section (AE elective cesarean section) refers to a caesarean section (CS) that is done on a pregnant woman who is not in labor, either on the basis of an obstetrical or medical indication or at the request of the pregnant patient. ... Childbirth in a hospital. ... A caesarean section (AE cesarean section), or c-section, is a form of childbirth in which a surgical incision is made through a mothers abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. ... Medical necessity is generally considered that which is reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care. ... Obstetrics (from the Latin obstare, to stand by) is the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium (the period shortly after birth). ... An indication is when something is indicated by methods of a reference. ... A pregnant woman near the end of her term Pregnancy is the carrying of one or more offspring in an embryonal or fetal stage of development by female mammals, including humans, inside their bodies, between the stages of conception and birth. ...

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.

When women with an extreme fear of childbirth undergo a CS, it is debatable have an indication or a CDMR. Fear of childbirth is not an isolated problem but associated with the womans personal characteristics, mainly general anxiety, low self-esteem, and clinical depression, as well as dissatisfaction with their partnership, and lack of support. ...

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: NIH can refer to: National Institutes of Health Norwegian School of Sports Sciences: (Norges idrettshøgskole - NIH) Not Invented Here This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ...

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.^[1] 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 infant respiratory distress syndrome.^[1] Urinary incontinence is the involuntary excretion of urine from ones body. ... The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Breastfeeding an infant Symbol for breastfeeding (Matt Daigle, Mothering magazine contest winner 2006) Breastfeeding is the feeding of an infant or young child with milk from a womans breasts. ... Infant respiratory distress syndrome (RDS, also called Respiratory distress syndrome of newborn, previously called hyaline membrane disease), is a syndrome caused by developmental lack of surfactant and structural immaturity in the lungs of premature infants. ...

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.^[4] 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. ^[5], however such a group would include women with medical or obstetrical indications.

References

1. ^ ^{a b c d e} 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. ^ MacDorman (2006). "and neonatal mortality for primary cesarean and vaginal births to women with "no indicated risk," United States, 1998-2001 birth cohorts". Birth 33(3): 175-82. PMID 16948717. 
5. ^ Liu, Shiliange, Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term Canadian Medical Association Journal, February 13, 2007; 176 (4).

External links

• Summary of 2006 NIH Report

• NIH Cesarean Conference: Interpreting Meeting and Media Reports