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Cesarean Section on 'Maternal Request'? Be Sure to Understand Your Risks

 

In modern obstetrics, there is a growing trend in expecting mothers’ request for ‘elective’ Cesarean section (‘Cesarean Section on Maternal Request’.)  This ‘elective’ cesarean delivery, is a maternal request for Cesarean section delivery, in the absence of any maternal or fetal need (nor medical indication) for Cesarean section birth.  (This particular ‘request’ for Cesarean section refers to a maternal request for a first-time Cesarean delivery… not a request for a repeat Cesarean birth, as in the case of a mother with previous Cesarean Section deliveries.)  In the U.S. 2.5% of births are performed by Cesarean section for this request.  In my experience, concern and anxiety regarding pain in labor seem to represent the most common reason for this request.

The most common medically indicated reasons for a primary (first time) Cesarean Section are:

  1. Failure to progress in labor – when in active labor, the progression of cervical dilation is halted.
  2. Concerns regarding  the fetal heart rate – fetal heart rate patterns that could represent present or pending concerns for fetal stress in further laboring.
  3. Fetal malpresentation – fetal  positions other than head-down (vertex), most commonly breech.

For patients considering a Cesarean Section on request, whether for reasons of convenience, fear of the pain or process of labor, or a previous ‘bad’ experience in labor, the risks versus benefits of a vaginal delivery over a Cesarean section must be considered.   The potential benefits of a vaginal delivery over a Cesarean section include:  shorter hospital stays, lowered infection rates, fewer anesthetic complications, and lowered surgical complication rates.

A Cesarean section is still a surgery, where the risks of surgical complication (such as bleeding, infection, and injury to internal organs) are overall, still higher than with a vaginal delivery.  Increased surgical risks aside, we should also not forget the potential risks posed to a subsequent pregnancy because of a history of a previous Cesarean section, those including:  the risks of uterine rupture, placenta previa, bowel and bladder injury, and surgical complications that could increase  the risk for hysterectomy at the time of a subsequent Cesarean section.  Because the obstetrical and surgical risks increase with each subsequent Cesarean section performed, a woman’s desire for several children/planned family size, should be a recognized factor in counseling women who may be considering Cesarean section on request.

If fear of pain in labor is what’s motivating you to consider a Cesarean section on request, speak with your Obstetrical care provider to learn more about your options for pain management in labor.  If a Cesarean section upon request still remains your desire, make sure you understand your risks.

 

Here is more information from ACOG on Cesarean Section on Maternal Request: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Cesarean_Delivery_on_Maternal_Request

 

Suzanne Hall, MD (@drsuzyyhall)

Eastside Gynecology Obstetrics, PC

Offices located in Roseville, Grosse Pointe, Macomb, Rochester MI

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