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Clinical Crossroads
Clinician's Corner
May 8, 2013

Elective Cesarean Delivery on Maternal Request

Author Affiliations

Clinical Crossroads Section Editor: Edward H. Livingston, MD, Deputy Editor, JAMA.

Author Affiliations: Dr Ecker is Professor, Harvard Medical School, and Director of Quality Assurance, Clinical Obstetric Research and Maternal Fetal Medicine Fellowship in the Department of Obstetrics and Gynecology at Massachusetts General Hospital, Boston.

JAMA. 2013;309(18):1930-1936. doi:10.1001/jama.2013.3982

Importance 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]).

Evidence Review 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.

Findings 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 and Relevance 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.