title: Maternal request: a reason for rising rates of cesarean section?
abstract: OBJECTIVE
  The rising rate of cesarean sections (CS), especially those on maternal request, is an important obstetric care issue. The aim of this two-point cross-sectional study was to evaluate the prevalence of CS and their indications.
  
  
  METHODS
  We performed a retrospective chart review of the indications of all CS performed at a tertiary care clinic in Switzerland in 2002 and 2008. Chi-square, Student's t and Mann-Whitney U tests were performed to identify significant differences.
  
  
  RESULTS
  The number of CS rose from 23.3% (371 out of 1,594 total life births) in 2002 to 27.5% (513 out of 1,866) in 2008 (p = 0.005). Of all deliveries, the rate of CS on maternal request and, among these, especially those requested after previous CS, increased significantly (2.1 vs. 5.1% and 0.3 vs. 1.2%, respectively). The number of CS due to previous traumatic birth experience nearly doubled (0.7 vs. 1.2%, not significant). Maternal and fetal complications were rare but not negligible in the subset of low-risk patients requesting CS.
  
  
  CONCLUSIONS
  The study demonstrated a significant increase in CS on maternal request, especially in case of previous CS. The findings of this study support the need for specific counseling strategies for women requesting delivery by CS.
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Nidwalden, Stans, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kottmel
authors.forename: Irene
authors.initials: I
authors.lastname: Hoesli
authors.forename: Rahel
authors.initials: R
authors.lastname: Traub
authors.forename: Corinne
authors.initials: C
authors.lastname: Urech
authors.forename: Dorothy
authors.initials: D
authors.lastname: Huang
authors.forename: Brigitte
authors.initials: B
authors.lastname: Leeners
authors.forename: Sibil
authors.initials: S
authors.lastname: Tschudin
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D036801:Parturition; D057240:Patient Preference / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric