Caesarean birth on maternal request

She is 32, well, 22 weeks pregnant with her first baby, and she says it almost as an aside: "I've decided I want a caesarean." The temptation is to answer the question she asked. The consultants who handle this well answer the question underneath it first — and about six times in ten, the request changes.^[8][9]

Overview and definition

Caesarean birth on maternal request (CBMR) is planned caesarean at the woman's request where there is no identifiable medical or obstetric contraindication to vaginal birth. Everything hinges on that clause: it is what separates a preference from an indication.^[1][2]

RANZCOG C-Obs 39 (approved July 2023) defines the population precisely as low risk — a cephalic singleton at term, a normally positioned placenta, no detected growth disorder, no maternal infection and no other chronic health condition. If any of those fails, you are no longer counselling a request; you are managing an indication.^[1]

• Antenatal request is what the guideline addresses. An intrapartum request is explicitly out of scope, which does not mean you may ignore one.^[1]
• The term itself is contested. C-Obs 39 asks for sensitivity around it, because a request driven by previous loss, or by interpersonal or sexual violence, may be legitimately medically indicated even though no obstetric box is ticked.^[8]

References16ShowHide

1. [1]American College of Obstetricians and Gynecologists ACOG Committee Opinion No. 761: Cesarean Delivery on Maternal Request. Obstet Gynecol, 2019.PMID 30575678
2. [2]National Institutes of Health National Institutes of Health state-of-the-science conference statement: Cesarean delivery on maternal request March 27-29, 2006. Obstet Gynecol, 2006.PMID 16738168
3. [3]Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol, 2006.PMID 16738145
4. [4]Marshall NE, Fu R, Guise JM Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol, 2011.PMID 22071057
5. [5]Keag OE, Norman JE, Stock SJ Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med, 2018.PMID 29360829
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7. [7]Tähtinen RM, Cartwright R, Tsui JF, et al. Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol, 2016.PMID 26874810
8. [8]Hofberg K, Brockington I Tokophobia: an unreasoning dread of childbirth. A series of 26 cases. Br J Psychiatry, 2000.PMID 10789333
9. [9]Saisto T, Salmela-Aro K, Nurmi JE, et al. A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol, 2001.PMID 11704175
10. [10]Smith GC, Pell JP, Dobbie R Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet, 2003.PMID 14654315
11. [11]Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med, 2004.PMID 15598960
12. [12]Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med, 2009.PMID 19129525
13. [13]Hansen AK, Wisborg K, Uldbjerg N, et al. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ, 2008.PMID 18077440
14. [14]Betran AP, Ye J, Moller AB, et al. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health, 2021.PMID 34130991
15. [15]Betran AP, Torloni MR, Zhang JJ, et al. WHO Statement on Caesarean Section Rates. BJOG, 2016.PMID 26681211
16. [16]Boerma T, Ronsmans C, Melesse DY, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet, 2018.PMID 30322584