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Comment & Response
September 4, 2013

Cesarean Delivery on Maternal Request

Author Affiliations
  • 1Sol Price School of Public Policy, University of Southern California, Los Angeles
  • 2Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
JAMA. 2013;310(9):978. doi:10.1001/jama.2013.194756

To the Editor We agree with Dr Ecker1 that equipoise currently exists around the question of cesarean delivery for nonmedical reasons at term. Nevertheless, several larger concerns arise.

The first is the practice of parsimonious medicine. Physicians have an obligation to deliver care that fits the needs and circumstances of their patients but that also actively avoids wasteful care.2 Because cesarean delivery costs approximately 30% more than vaginal delivery for privately insured women, actively avoiding waste could mean systematically persuading women against such elective procedures. People are “present biased”3 and are likely to discount bad outcomes to children in the future that will be brought about by an elective cesarean in the present. However, there are effective approaches that may be used in talking with patients to reduce present bias.3