Absence Of Medical Indication Research Articles

Association between mode of delivery and early neurodevelopment: A prospective birth cohort study.

This study suggested that the adverse impact of CD on child neurodevelopment stems from the procedure itself rather than CD-related medical conditions. It is important to minimize the use of CD when there is no medical necessity. • Caesarean delivery (CD) may influence child neurodevelopment and other long-term outcomes. • In China, approximately one-quarter of CD are performed due to maternal request without medical indications. • The negative impact of CD on the neurodevelopmental outcomes of children may be primarily attributed to the procedure itself, as opposed to related medical conditions. • In the absence of medical indications, unnecessary CD may have adverse impacts on children's neurodevelopment.

Estimating the prevalence of dyspareunia according to mode of delivery: a systematic review and meta-analysis

The present study aimed to examine the prevalence of dyspareunia in the post-partum period in relation to the mode of delivery. In this systematic review and meta-analysis, published articles until February 2020 were searched through the related key term based on mesh term in national and international databases. In the initial search, 1391 articles were found that after removing duplicate, unrelated or non-English and non-Persian articles, finally 20 studies with a sample size of 11354 of women who had given birth were introduced in this study. The prevalence of dyspareunia following vaginal delivery, C-section, and instrumental delivery with 95%CI was 42%(31–56%), 26%(19–34%), and 37%(28–46%) respectively. In addition, the prevalence of dyspareunia in primiparous was higher than multiparous (34%vs.24%), in breastfeeding women was higher than non-breastfeeding women (48%vs.33%), in women who non-used hormonal contraceptive methods were higher than who used hormonal contraceptive methods (43%vs.35%) and its prevalence was similar in women with and without episiotomy. The results indicated that vaginal delivery, breastfeeding, used hormonal contraceptive and primiparity have an impact on dyspareunia. Thus, considering the high prevalence of dyspareunia, and its impact on the quality of life of couples in the postpartum period, attention to, planning, and designing effective interventions in this regard are essential. IMPACT STATEMENT What is already known on this subject? Dyspareunia is one of the common experiences of women in the post-partum period. One of the most important factors affecting dyspareunia in the post-partum period is the mode of delivery. What do the results of this study add? The present study adds to examine the prevalence of dyspareunia in the postpartum period in terms of the mode of delivery. So far, no study has been found which comprehensively and systematically estimating the prevalence of dyspareunia in relation to the type of delivery mode in women who have given birth recently. In addition to the type of delivery the prevalence of dyspareunia was estimated based on parity, breastfeeding, episiotomy and consumption of hormonal contraceptive status. What are the implications of these findings for clinical practice and/or further research? This finding will be a small step to familiarise physicians and midwives as well as people with the relationship between delivery mode and dyspareunia. In addition, in the absence of medical indications and the possibility of choosing the mode of delivery selectively, help them decide and choose the appropriate method of termination of labour and ultimately improve the mental and physical health of the birthing person, family and community.

Fertility of tomorrow: Are there any restrictions left?

As the concepts of society, parenthood and family evolve, the French law on bioethics has recently been updated by authorizing oocyte and sperm cryopreservation for all individuals who wish to do so, in the absence of medical indications. For women, aging irremediably impairs reproductive competence, both quantitatively and qualitatively. For men, aging has a negative impact on sperm parameters. Hence, this possibility of social oocyte/sperm freezing is a real breakthrough, offering to all the opportunity to better anticipate age-related fertility decline and be better actors of one's reproductive life. In its current form, the new French bioethics law allows unrestricted access to fertility preservation techniques to all women and men that fulfill the age criteria. In light of the lack of official recommendations, many questions remain. In clinical practice, it is therefore up to centers to determine on a case-by-case basis the limits of these procedures, notably to define when to stop fertility preservation. This also questions the place of the patient as a decision maker in the procedure and to which extent these procedures should be performed according to patient preference. Altogether, despite the wide range of possibilities enabled by these major legal and technical advances, it is essential to make clear to all that undergoing fertility preservation procedures is not a guarantee of future pregnancy and does not replace timely care of fertility issues.

Place of Birth Preferences and Relationship to Maternal and Newborn Outcomes Within the American Association of Birth Centers Perinatal Data Registry, 2007-2020.

The purpose of this study was to describe sociodemographic variations in client preference for birthplace and relationships to perinatal health outcomes. Descriptive data analysis (raw number, percentages, and means) showed that preference for birthplace varied across racial and ethnic categories as well as sociodemographic categories including educational status, body mass index, payer status, marital status, and gravidity. A subsample of medically low-risk childbearing people, qualified for birth center admission in labor, was analyzed to assess variations in maternal and newborn outcomes by site of first admission in labor. While overall clinical outcomes exceeded national benchmarks across all places of admission in the sample, disparities were noted including higher cesarean birth rates among Black and Hispanic people. This variation was larger within the population of people who preferred to be admitted to the hospital in labor in the absence of medical indication. This study supports that the birth center model provides safe delivery care across the intersections of US sociodemographics. Findings from this study highlight the importance of increased access and choice in place of birth for improving health equity, including decreasing cesarean birth and increasing breastfeeding initiation.

Women with maternal near-miss in the intensive care unit in Yangzhou, China: a 5-year retrospective study

BackgroundAnalysis of “maternal near-misses” is expected to facilitate assessment of the quality of maternity care in health facilities. Therefore, this study aimed to investigate incidence, risk factors and causes of maternal near-misses (MNM) admitted to the intensive care unit (ICU) within five years by using the World Health Organization’s MNM approach.MethodsA five-year retrospective study was conducted in Subei People’s Hospital of Yangzhou, Jiangsu Province from January 1, 2015 to December 31, 2019. Risk factors in 65 women with MNM in the intensive care unit (ICU) were explored by using chi-square tests and multivariable logistic regression analysis. Causes and interventions in MNM were investigated by descriptive analysis.ResultsAverage maternal near-miss incidence ratio (MNMIR) for ICU admission was 3.5 per 1000 live births. Average maternal mortality ratio (MMR) was 5 per 100,000 live births. MI for all MNM was 0.7%. Steady growth of MNMIR in ICU was witnessed in the five-year study period. Women who were referred from other hospitals (aOR 3.32; 95%CI 1.40–7.32) and had cesarean birth (aOR 4.96; 95%CI 1.66–14.86) were more likely to be admitted in ICU. Neonates born to women with MNM admitted in ICU had lower birthweight (aOR 5.41; 95%CI 2.53–11.58) and Apgar score at 5 min (aOR 6.39; 95%CI 2.20–18.55) compared with women with MNM outside ICU. ICU admission because of MNM occurred mostly postpartum (n = 63; 96.9%). Leading direct obstetric causes of MNM admitted in ICU were hypertensive diseases of pregnancy (n = 24; 36.9%), followed by postpartum hemorrhage (n = 14; 21.5%), while the leading indirect obstetric cause was heart diseases (n = 3; 4.6%).ConclusionsRisk factors that were associated with MNM in ICU were referral and cesarean birth. Hypertensive disease of pregnancy and postpartum hemorrhage were the main obstetric causes of MNM in ICU. These findings would provide guidance to improve professional skills of primary health care providers and encourage vaginal birth in the absence of medical indications for cesarean birth.

Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences.

Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women's preferences for mode of birth and factors underlying preferences for CS. Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual. We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women's partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021. Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth (High confidence), uncertainty regarding vaginal birth (High confidence), and positive views or perceived advantages of CS (High confidence). Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births (High confidence). The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth (High confidence). A wide variety of factors underlie women's preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.

Frequency of Caesarean Delivery on maternal request in a private teaching hospital

Introduction: Caesarean section rates are increasing worldwide. There are many reasons for this increasing caesarean section rate one of them is increasing requests by women for caesarean section in the absence of medical indications. Most women think that elective caesarean section is safe both for women and babies. Some clinician also considered caesarean section safe. An increasing rate of caesarean section is alarming in developed as well as underdeveloped countries.
 Objective: To investigate the frequency of caesarean section on maternal request and factors leading to it in a private teaching hospital.
 Materials and Methods: This was a cross-sectional descriptive study carried out at Shalamar hospital from 1st May 2018 to 30th April 2019. Women of all ages who were pregnant and were going to have caesarean delivery during the study period at Shalamar hospital.
 Results: There were 3438 total births during the study period. There were 2380(69%) caesarean section and 1058(31%) were normal vaginal deliveries. Caesarean section rate was 69%. Caesarean sections performed on maternal request were 167(7%) out of 2380 caesarean. Out of these 167 Seventy-two, 43.1% of women were those who already have a previous caesarean section for different non-recurrent indications and now they don’t want the trial of labour and requested for caesarean section. Forty, 24% of women requested for a caesarean section because of fear of labour pains and eighteen, 10.8% were those who had a bad experience of the previous child-birth. Twelve, 7.2% of women had fear of failed vaginal delivery and eight women had fear of trauma to baby and three, 1.8% had fear of perineal trauma during the trial of normal vaginal delivery. Six, 3.6% of women had some social reasons for caesarean section and six, 3.6% had some bad experience of normal delivery of their relatives or friends and two, 1.2% were those who were requesting caesarean section because of their family members preferences.
 Conclusion: Most of the women requesting for caesarean section were those who had previously trial of labour. We can control the caesarean section rate by proper counselling of pregnant women.

Motives for - and prevalence of - cesarean delivery on maternal request: A survey in Saudi Arabia.

Background: Although cesarean delivery on maternal request (CDMR) has been associated with an increase in the frequency of cesarean sections (CSs), there is a lack of studies reporting the frequency of CDMR in Saudi Arabia. This study was conducted to estimate the prevalence of and the motives for CDMR and identify its associated factors. Methods: This cross-sectional study was conducted between March and June 2017 on 364 pregnant women who planned a CS at King Abdulaziz Medical City in Riyadh. The characteristics of the women and their motives for undergoing a CS for the current pregnancy term were collected. Results: The prevalence of CDMR was found to be 13.7% (50/364) [95% confidence interval (CI): 10.370%–17.706%]. Older maternal age ( ≥ 40 years) [adjusted odds ratio (aOR) = 3.9; p = 0.019], family history of CS (aOR = 2.9; p = 0.038), non-Saudi nationality (aOR = 5.0; p = 0.050), and receiving education or medical information about the possibility of delivering by CS (aOR = 13.7; p = 0.030) were significantly associated with a higher prevalence of CDMR. As the number of previous CSs increased by one (aOR = 0.6; p = 0.011), the odds of CDMR decreased by 40%. The most common motives for demanding a CS in the absence of medical indications were avoiding labor or possible complications from vaginal birth (60%) and fear of pain on vaginal delivery (46%). Conclusions: A high prevalence of CDMR was documented at King Abdulaziz Medical City, especially among women of older maternal age, having a family history of CS, of non-Saudi nationality, and who received education or medical information about the possibility of delivering by CS. Counseling programs might be helpful for pregnant women who fear pain in vaginal delivery or have had a previous traumatic birth experience.

Obstetrical Providers’ Preferred Mode of Delivery and Attitude Toward Nonmedically Indicated Caesarean Sections: A Cross-Sectional Study

(BJOG. 2018;125:1294–1302) There has been an international rise in cesarean section (CS) rates, sometimes attributed to an increase in nonmedically indicated CS, including CS on maternal request (CSMR). Some evidence has suggested that women prefer vaginal delivery, however, and provider’s attitudes may have a greater effect on this trend. This study used a sample of Argentine obstetrical providers and described their preferred modes of delivery and attitudes towards CS in the absence of medical indication and CSMR.

Cesarean sections. Associated factors and frequency at King Abdulaziz Medical City in the Central Region of the Kingdom of Saudi Arabia.

Objectives:To study the associated factors for cesarean section (C-section) in a sample of pregnant women and to estimate its frequency at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia (KAMC-R).Methods:We studied 364 pregnant women who attended the Gynecology and Obstetrics Clinic at KAMC-R between March and June 2017.Results:Our 3-month study had higher rates of C-sections: women with older maternal age; (adjusted risk ratio [aRR]=1.08, p=0.001), lack of education (aRR=1.39, p=0.022), no personal history of vaginal delivery (aRR=1.85, p=0.001), undergoing C-section due to medical indications (aRR=2.28, p=0.001), and willing to repeat a C-section in the absence of medical indications (aRR=1.49, p=0.006). Cesarean section occurred in 27% of the total deliveries in 2016.Conclusion:Cesarean section are very frequent and prevalent in our center, and may be increasing. The frequency of C-sections was significantly higher for women of older maternal age, little education, no personal history of vaginal delivery, undergoing C-sections due to medical indications, and those willing to repeat a C-section in the absence of medical indications.

Development of a Questionnaire to Measure Attitude Toward Birth Method Selection.

Background:The rate of mothers undergoing cesarean section in the absence of medical indication is increasing in the world. Women attitude have an essential role in the request or selecting a birth mode. This study aimed to develop a scale for measuring attitude toward birth method selection.Materials and Methods:The study was conducted in two qualitative and quantitative parts. Data collection was conducted from June to December 2012 in Ahvaz, Iran. In the qualitative part of the study, 21 interviews were conducted with pregnant or parturient women and key informants. Consequently, content and face validity were performed to provide a pre-final version of the questionnaire. Then, in the quantitative part of the study, validity, exploratory factor analysis, and reliability were performed to assess the psychometric properties of the scale.Results:A 130-item questionnaire was developed through the qualitative phase. It was reduced to an 82-item questionnaire after content and face validity. Exploratory factor analysis loaded a 68-item with an 8-factor solution (“beliefs and attitudes,” “sexual and physical attitudes,” “fear of childbirth,” “preference of convenience, health, and supporting,” “socio- cultural norms,” “confidence to the birth practitioner,” “personal and practical choice,” and “sources of motivations,” which jointly accounted for 42.97% of the observed variance. Cronbach's alpha coefficient showed excellent internal consistency (α = 0.87), and test–retest of the scale with 2-week intervals indicated an appropriate stability for the scale (0.89).Conclusions:The findings showed that the designed questionnaire was a valid and reliable instrument for indicating the pregnant womens' attitudes to their birth method selection. Also, ATBMS is an easy use questionnaire and contains the most significant factors persuading women to choose vaginal delivery or cesarean section.

Need for Innovations.

Among the greatest challenges in obstetrics today are the high cesarean section rates. For a number of years, the AKF Working Group on Women’s Health in Medicine, Psychotherapy, and Society has raised awareness on this issue (www.kaiserschnittkampagne.de). Its commitment to promoting women’s health on a political level across disciplines has significantly contributed to getting an S3 guideline on indications for cesarean section underway. Apart from high-quality guidelines capable of improving the quality of the practical work in the delivery rooms, it is essential to address the structural, organizational and economic conditions which have contributed to the decline in normal births. The following innovations would contribute to the development of modern, safe, women- and family-centered obstetrics: Early and routine integration of midwives in prenatal care could lessen the focus on risk and technology which dominates today’s obstetric care; Nationwide implementation of one-on-one care in delivery rooms is a prerequisite for a relationship-centered and progressive culture of giving birth; Making the topic of physiology of birth an integral part of the medical training curriculum would promote a deeper understanding of the normal process of giving birth; Establishing regular, joint reflection rounds of the delivery room staff as well as planned basic and advanced training events addressing special obstetric situations would enhance the ability of doctors and midwifes to handle special and emergency situations; and the removal of the wrong financial incentives existing under the DRG system, which discourage natural birth, would alleviate economic pressure. Maternal request for cesarean section in the absence of medical indications, mainly driven by fear of giving birth (1), represents a particular challenge. It is known that many pregnant women change their mind after in-depth advice and retrospectively rate their decision to have a normal birth as good (2). This highlights the high importance of comprehensive advice and a trustful relationship. Obstetric care in Germany could be advanced a step further by developing, applying and evaluating structured and quality-assured consulting concepts.

The influence of women's preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study.

BackgroundThis study aimed to examine whether a mismatch between a woman’s preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth.MethodsThe study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women’s preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups.ResultsExamining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p < 0.001). However, Bonferroni post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety.ConclusionsThe results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms. These women, who often fear childbirth, may prefer a cesarean section even though vaginal delivery is usually the best option in the absence of medical indications. To avoid potential trauma, fear of childbirth and maternal requests for a cesarean section should be taken seriously and responded to adequately.

Iranian mothers' selection of a birth method in the context of perceived norms: A content analysis study

Objectiveto describe women's perceptions of choosing a particular birth method; normal childbirth or caesarean section in the absence of medical indications. Designa descriptive qualitative content analysis was used for data gathering and analysis. Interviews were held with 18 pregnant and postnatal women. The participants were recruited using a purposive sampling method. Interviews were begun with a general question and were followed with specific questions. Settingthree semi-public and public hospitals and two health care centres in an urban area of Iran were the locations of data gathering. Data analysis and data collection were conducted concurrently and interviews were discontinued when data saturation was reached. Participantsthe participants consisted of 18 women (four pregnant and 14 postnatal) recruited using a purposive sampling method. Findings‘socio-economic and cultural norms’ was the main theme that emerged in this study. Four other categories comprised the content of interviews: ‘cultural and religious acceptance’, ‘social acceptance’, ‘psychological–social support’, and ‘economical acceptance’. Conclusions and implicationssocio-cultural, religious and economical norms in the Iranian society play main roles in the selection of the birth method by Iranian women. Health care policy-makers are expected to attend to the factors influencing women's decision-making on the childbirth method to reduce the number of unnecessary caesarean sections.

PL.78 Maternal Request for a Caesarean Section in the Absence of Medical Indications

IntroductionCS rates are rising worldwide. In the UK, 25% of women have a CS and 6–8% of women express a preference.1 2NICE recently updated guidelines stating that women can request...

First-time mothers' wish for a planned caesarean section: Deeply rooted emotions

Backgroundinternational estimates suggest that caesarean section on maternal request range from 4% to 18% of all caesarean section. An increasing number of surveys have investigated women's reasons for a caesarean section in the absence of a medical indication but few studies have solely studied first-time mothers motivation for this request. Objectiveto describe the underlying reasons for the desire for a caesarean section in the absence of medical indication in pregnant first-time mothers. Methoda qualitative descriptive study, with content analysis of interviews with 12 first-time mothers. Findingsthe overarching theme formulated to illustrate the central interpreted meaning of the underlying desire for a planned caesarean section was based on deeply rooted emotions'. Four categories were identified as related to the request for a caesarean section on maternal request. The categories was identified as ‘always knowing that there are no other options than a caesarean section’, ‘caesarean section as a more controlled and safe way of having a baby’, own negative experiences of health care and having problems dealing with other people's reaction about their mode of delivery. Conclusionthe results show that for these first-time mothers deeply rooted emotions described as stronger than fear of birth were behind their wish for a planned caesarean section.

Having an Elective Cesarean: Doing What's Best for Me

To determine how women decide to deliver their infants by cesarean instead of experiencing a trial of labor and expected vaginal delivery when appropriate. The specific goals were to answer the research questions: What is the decision-making process by which healthy, low risk women choose to give birth to their infants by cesarean in the absence of medical indications? What antecedents occur to influence a pregnant woman's decision to undergo a maternal request cesarean?

Cesarean section without clinical indication versus vaginal delivery as a paradigmatic model in the discourse of medical setting decisions

Natural childbirth has ceased to be considered the gold standard in the delivery room.For this reason cesarean section on demand is increasing. Many obstetricians justify this phenomenon on evidence-based obstetrical practice. However, other pieces of evidence demonstrate that the data are often a product of the social milieu, and as stated by Wendland, “technology magically wards off the unpredictability and danger of birth”. In a recent paper, Kalish pointed out several problems with cesarean deliveries in the absence of medical indications regarding issues of good clinical practice, autonomy, and informed consent. From the late 1990s, the medical community began to speak in favor of women's autonomy in childbirth decisions thus supporting the maternal choice and request for a cesarean section. Starting from these new considerations, it is of primary importance to understand whether emphasizing patient's autonomy is the best, or the only, way to helping the medical decisional process. This general approach may be helpful in all the other cases in which patient's autonomy and physician's responsibility appear to be intertwined in an apparent conflicting manner. We fear that the rhetoric of autonomous choice represents a fundamental shift from medicine-based beneficence toward a perilous relationship founded mainly on patient's wishes, representing a dangerous slippery slope where the physician could be reduced to the role of a functionary delegated to execute patient's claims and demands.

Influences on Decision Making Among Primiparous Women Choosing Elective Caesarean Section in the Absence of Medical Indications: Findings From a Qualitative Investigation

ObjectivePatient-initiated elective Caesarean section (PIECS) is increasingly prevalent and is emerging as an urgent issue for individual maternity practitioners, hospitals, and policy makers, as well as for maternity patients. This qualitative study sought to explore women’s experiences of the decision-making process leading to elective operative delivery without medical indication. MethodsWe conducted 17 exploratory qualitative in-depth interviews with primiparous women who had undergone a patient-initiated elective Caesarean section in the absence of any medical indication. The study took place in five hospitals (three urban, two semi-rural) in British Columbia. ResultsThe findings revealed three themes within the process of women deciding to have a Caesarean section: the reasons for their decision, the qualities of the decision-making process, and the social context in which the decision was made. The factors that influenced a patient-initiated request for delivery by Caesarean section in participants in this study were diverse, culturally dependent, and reflective of varying degrees of emotional and evidence-based influences. ConclusionPIECS is a rare but socially significant phenomenon. The a priori decision making of some women choosing PIECS does not follow the usual diagnosis-intervention trajectory, and the care provider may have to work in reverse to ensure that the patient fully understands the risks and benefits of her decision subsequent to the decision having been made, while still ensuring patient autonomy. Results from this study provide a context for a woman’s request for an elective Caesarean section without medical indication, which may contribute to a more efficacious informed consent process.

Caesarean section at maternal request: a literature review

UK caesarean section rates have seen an exponential rise in recent years. Despite recommendations from the Expert Maternity Group to implement woman-centred maternity services that encourage natural birth, and despite the publication of National Institute for Health and Clinical Excellence (NICE) guidelines in 2004, rates of abdominal delivery continue to increase. Caesarean section performed at a patient's request in the absence of medical indications is the source of extensive debate in the media and the medical professions. In 2002, 7.3% of all primary caesarean sections in the UK were performed at maternal request, costing the NHS in excess of £10 million. The reasons behind such requests are varied and often are influenced by social, cultural, emotional and economic factors. This review explores factors that influence some women's preference for elective caesarean section over vaginal delivery and discusses the existing evidence.