title: Elective cesarean delivery on maternal request.
abstract: OBJECTIVE
  Some pregnant women prefer cesarean delivery and request it without maternal or fetal indication rather than proceeding with a plan for vaginal delivery.
  
  
  OBJECTIVE
  To review approaches for counseling women who ask for cesarean delivery without maternal or fetal indication (known as cesarean delivery on maternal request [CDMR]).
  
  
  METHODS
  An Agency for Healthcare Research and Quality evidence report of studies published after 1990, a 2006 National Institutes of Health state-of-the-science conference report, and published literature were examined.
  
  
  RESULTS
  The prevalence of CDMR in the United States is not precisely known but probably occurs in less than 3% of all deliveries. Most practicing obstetricians have received requests for CDMR from patients. Compared with a plan for vaginal delivery, CDMR may be associated with lower rates of hemorrhage, maternal incontinence, and rare but serious neonatal outcomes. However, CDMR is associated with a higher risk of neonatal respiratory morbidity. Adverse consequences of CDMR may be manifested only in future pregnancies. Repeated cesarean deliveries have higher rates of operative complications, placental abnormalities such as placenta previa and accreta, and consequent gravid hysterectomy.
  
  
  CONCLUSIONS
  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.
authors: Harvard Medical School, and Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA. jecker@partners.org
authors: Jeffrey
authors: J
authors: Ecker
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000941:ethics / Q000592:standards / Q000706:statistics & numerical data; D003376:Counseling; D003657:Decision Making; D017558:Elective Surgical Procedures / Q000941:ethics / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010347:Patient Care Planning; D057240:Patient Preference; D011183:Postoperative Complications; D011247:Pregnancy; D011248:Pregnancy Complications; D015995:Prevalence; D012306:Risk; D014481:United States / Q000453:epidemiology