Cesarean delivery on maternal request: maternal and neonatal complications

Abstract

A complicated but relevant and timely concept, cesarean delivery on maternal request (CDMR) is defined as a cesarean delivery for a singleton pregnancy on maternal request at term in the absence of medical or obstetrical indications. Multiple potential risks and benefits exist with both vaginal and cesarean deliveries. A CDMR performed prior to the onset of labor for a mother planning on only one or two children may be reasonable after informed consent and counseling. However, the most concerning complications from cesareans are the neonatal respiratory morbidity and the impact on a mother's future reproductive health, including the risk of abnormal placentation such as placenta previa or accreta. The literature on CDMR is limited and is derived primarily from observational or extrapolated studies. A well designed prospective study does not currently exist but is needed comparing the optimal groups of planned vaginal delivery and planned CDMR. Discussions regarding CDMR should be individualized. Until there are more data on CDMR and guidelines implemented, an explicitly executed informed consent should form the framework of any decision regarding mode of delivery.