In Reply Cesarean delivery on maternal request remains controversial. My article did not have space to discuss every potential effect of CDMR on maternal or neonatal health, but I pointed readers toward more comprehensive reviews such as that conducted for the National Institutes of Health consensus conference.1
Dr Li and colleagues point to emerging evidence of possible long-term effects on pediatric health associated with cesarean delivery. Data for the hygiene hypothesis are limited by the absence of randomized trials and are subject to confounding. As more data emerge and the magnitude of risk becomes more clearly quantified, such outcomes may be part of the conversation between patients and physicians concerning CDMR. How patients weigh these outcomes against the reasons for CDMR will vary among individuals.
Ecker J. Cesarean Delivery on Maternal Request—Reply. JAMA. 2013;310(9):978-979. doi:10.1001/jama.2013.194777