Cesarean Delivery On Maternal Request

A study recently published in the Green Journal (Obstet Gynecol 2009;113:812-6) examined the "prognosis" for women who have spontaneous labor and what implications for maternal request cesarean delivery there might be.

"The cesarean delivery rate hit a record high in the United States in 2006, when almost one third of all births (31.1%) were cesarean deliveries. This rate equates to a 50% increase in the past 10 years, and, although the decline in vaginal births after cesarean has contributed to an increase in repeat cesareans, the primary cesarean rate is on the rise as well. The reasons for these increases are many bu most recently included the controversial use of cesarean in response to maternal request.

There are no definitive estimates on the proportion of such maternal-request cesareans, but rates as high as 6% of all births in the United States have been described.

Our most important finding in women with normal term pregnancies and spontaneous labor is the extremely high rate of safe vaginal delivery regardless of parity.

That is, parturients need to be made aware of the excellent obstetrical prognosis that they forgo when choosing elective cesarean delivery."

We're in a medical era where celebrities have put cesarean-on-request on the general public's collective radar and physician litigation risk is at an all-time high. This seeming "perfect storm" has raised concern in the obstetrical community because as this study shows, there is much to be said for allowing labor in uncomplicated pregnancies. Maybe it pays to let mother nature do its thing.