Elective cesarean section on maternal request without indication: reasons for it, and its advantages and disadvantages (original) (raw)
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Reasons for Elective Cesarean Section amongst Pregnant Women; A Qualitative Study
Journal of reproduction & infertility, 2012
A qualitative study was carried out on 200 pregnant women attending obstetric offices and Imam Ali Women's Clinic in Zahedan, Iran during January 2010 to August 2011. Twenty-nine focus group discussions (FGDs) with 5-8 participants in each group were formed. The study included women in the third trimester of pregnancy with the intention or decision to undergo elective cesarean section. The women's views were explored and analyzed in group sessions. Subsequently, the responses were divided into four major categories. The majority (50%) of the opinions expressed were psychological in origin, or stemmed from low perceived behavioral control, improper subjective norms, or wrong attitudes about vaginal delivery. Twenty-nine focus group discussions (FGDs) with 5-8 participants in each group were formed. The study included women in the third trimester of pregnancy with the intention or decision to undergo elective cesarean section. The women's views were explored and analyzed i...
Cesarean section on maternal request: the viewpoint of expectant women
Archives of Gynecology and Obstetrics, 2013
To determine the women's perception and factors influencing willingness to have cesarean section on maternal request (CSMR) in the absence of medical or obstetric indication. A cross-sectional questionnaire-based survey of 752 antenatal clinic attendees at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti. Pre-tested questionnaires were used to elicit information on socio-demographic and obstetric variables, awareness and perspective of CSMR and the willingness to request CS without physician's recommendation. Frequency tables were generated and univariate and multivariate logistic regression were used to determine factors that influenced CSMR using SPSS software version 16.0. Forty-eight (6.4 %) of the respondents reported willingness to request CS. The most common motivations for the request were fear of losing the baby during labor, delay in conception and fear of labor pains. Analysis by simple logistic regression and multiple regression showed age, parity and educational status were not significantly related to the decision for CSMR. CSMR is an evolving entity in obstetrics practice in the developing countries. Delay in conception, fear of labor pain and loss of baby during labor appear to be strong motivations.
Mother-requested cesarean delivery compared to vaginal delivery: a systematic review
Revista Da Associacao Medica Brasileira, 2014
The rates of c-sections without medical or obstetric indication have increased substantially in the last decades, especially in developing countries. Many factors contribute to this increase, being the mother-requested cesarean delivery a key contributing factor. There is a major debate about the implementation of c-sections performed at the mother's request without any established medical indication, and safety, cost, maternal autonomy, maternal and professional satisfaction, and ethics constitute important factors under discussion.
Indications and determinants of cesarean section: A cross-sectional study
International Journal of Applied and Basic Medical Research, 2020
Background: Cesarean section is one of the most commonly performed surgeries in obstetric practice for saving the lives of women and their newborns from pregnancy-and childbirth-related complications. Its prevalence has increased alarmingly in the last few years, which has motivated this research to identify the indications and determinants, influencing cesarean section delivery in the study area and determine the associated correlates for emergency and elective cesarean sections. Materials and Methods: This was a hospital-based cross-sectional study conducted at a tertiary care center from April 2019 to September 2019. A quantitative tool was designed to capture all the relevant information regarding sociodemographic factors, obstetric characteristics, and indications of cesarean section among the pregnant women delivering at the tertiary care center. Results: A total of 150 women with cesarean deliveries were included in this study. The percentage of primigravida women was significantly higher among emergency than elective cesarean section (χ 2 = 28.19, P = 0.0001). Majority of the women were illiterate or had primary education in emergency cesarean section than elective (χ 2 = 44.9691, P = 0.0001). Majority of the women with no or only one antenatal visit underwent emergency than elective cesarean sections (χ 2 = 42.2195, P = 0.0001). Those females who presented with previous Lower Segment Cesarean Section (LSCS) had greater chances of elective cesarean section, and it was statistically significant (P = 0.004). Conclusion: The increase in cesarean section rate causes burden to the general health system and also strain on the family members. Hence, caution should be exercised in decision-making to perform cesarean section, especially for primigravida, and a comprehensive evidence-based approach needs to monitor the indication of cesarean section.
A Critique of the Literature on Women’s Request for Cesarean Section
Birth, 2007
Background: The influence of women's birth preferences on the rising cesarean section rates is uncertain and possibly changing. This review of publications relating to women's request for cesarean delivery explores assumptions related to the social, cultural, and politicaleconomic contexts of maternity care and decision making. Method: A search of major databases was undertaken using the following terms: ''c(a)esarean sectionSeventeen papers examining women's preferred type of birth were retrieved. Results: No studies systematically examined information provided to women by health professionals to inform their decision. Some studies did not adequately acknowledge the influence of obstetric and psychological factors in relation to women's request for a cesarean section. Other potential influences were poorly addressed, including whether or not the doctor advised a vaginal birth, women's access to midwifery care in pregnancy, information provision, quality of care, and cultural issues. Discussion: The psychosocial context of obstetric care reveals a power imbalance in favor of physicians. Research into decision making about cesarean section that does not account for the way care is offered, observe interactions between women and practitioners, and analyze the context of care should be interpreted with caution. (BIRTH 34:4 December 2007)
Obstetrics & Gynecology International Journal, 2023
Background: Cesarean Section on Maternal Request (CSMR) is a growing phenomenon whose literature needs to be appraised, and it is exemplified by a steady increase in the world neck and neck by high percentage of births by CS. It is even more luckless that giving birth by elective CS based on the pregnant woman's choice has become the first place among the justifications, notwithstanding its direct and long-term complications. Methods: This retrospective study reviewed data of all CS deliveries during the year 2022 at our hospital using electronic medical records in the hospital information system. Retrieved data include baseline demographic characteristics, mode of delivery, indications, and the type of CS, aiming to clarify the reason for CS to challenge the percentage of CS based on the yearning of the pregnant woman without a medical reason; to identify, analyze and try to solve the ethical problem raised up by the pregnant woman's request for CS. Results: The results revealed two significant facts; a sturdy noteworthy increase in the percentage of pregnant women delivering by CS compared to vaginal delivery at 54% versus 45.6%, and a sharp increase in the CS deliveries on maternal requests at 22.78%. The main reason for this shifting practice is the previous one CS followed by a decision that was taken on personal and family convictions. These harvested results revealed a significant increase in the percentage of pregnant women not receiving proper antenatal counseling about the appropriate method of delivery, with improper justification to jump over nature. Conclusion: Cesarean section should be signposted when on earth there is any indication or menace of detriment to the maternal and fetal binomial. If in earlier times "labor death" was a fact of life, nowadays it is astonishing and disgraceful the death of a mother due to pregnancy-delivery-postpartum. The proclamation that vaginal delivery is better because it is "natural" cannot and should not be taken to the last consequences under the risk of bad luck. The best form of birth is the safe one. To provide every pregnant woman with the right to choose her child's mode of delivery is to arbitrate for her sovereignty, yielding her respect and pride, nonetheless, it should be minimalistic and not absolute under this banner. Minimizing the rate of primary CS carries the secret key to ideal obstetrical care.
Cesarean Delivery: Background, Trends, and Epidemiology
Seminars in Perinatology, 2006
OBJECTIVE To examine trends in cesarean delivery for the overall population and for women with "no indicated risk" for cesarean section, and to summarize the available literature on "maternal request" cesarean deliveries. FINDINGS Nearly 3 in 10 births were delivered by cesarean section in 2004 (29.1%), the highest rate ever reported in the United States. The overall rate has increased by over 40% since 1996, reflecting two concurrent trends: an increase in the primary rate (14.6% to 20.6%), and a steep decline in the rate of vaginal birth after cesarean (28.3% to 9.2%). There has been a clear increase in primary cesarean delivery without a medical or obstetrical indication, and studies using hospital discharge data or birth certificate data estimate the rate of primary cesarean deliveries with no reported medical or obstetrical indication to be between 3% and 7% of all deliveries to women who had not had a previous cesarean delivery. However, these studies contain no direct information on whether these cesareans were the result of maternal request or because of physician recommendation. There was little data to support the contention that the rise in the cesarean rate was the result of maternal request. CONCLUSION There are no systematic data available on cesarean delivery by "maternal request." However, the rate of primary cesarean delivery is increasing rapidly for women of all ages, races, and medical conditions, as well as for births at all gestational ages. Since a first cesarean section virtually guarantees that subsequent pregnancies will be cesarean deliveries (the repeat cesarean delivery rate is now almost 91%), research is needed on physician practice patterns, maternal attitudes, clinical outcomes for mother and infant (harms, benefits), and clinical and nonclinical factors (institutional, legal, economic) that affect the decision to have a cesarean delivery. Semin Perinatol 30:235-241.
Birth, 2012
The scientific literature was silent about a relationship of pelvic floor, urinary, and fecal incontinence and sexual issues with mode of birth until 1993, when Sultan et al's impressive rectal ultrasound studies were published. They showed that perirectal fibers were damaged in many vaginal births, but not as a result of a cesarean section. These findings helped to pioneer a new area of research, ultimately leading to increasing support among health professionals and the public that maternal choice of cesarean delivery could be justified-even that maternal choice and autonomous decision-making trump other considerations, including evidence. A growing number of birth practitioners are choosing cesarean section for themselves-usually on the basis of concerns over pelvic floor, urinary incontinence, and sexual issues. Behind this choice is a training experience that focuses on the abnormal, interprets the literature through a pathological lens, and lacks sufficient opportunity to see normal childbirth. Cesarean section on maternal request is a complex issue based on fear and misinformation that is a symptom of a system needing reform, that is, a major change in community and professional education, governmental policy making, and creation of environments emphasizing the normal. Systemic change will require the training of obstetricians mainly as consultants and the education of a much larger cadre of midwives and family physicians who will provide care for most pregnant women in settings designed to facilitate the normal. Tinkering with the system will not work-it requires a complete refit. (BIRTH 39:4 December 2012)
Elective Cesarean Section and Decision Making: A Critical Review of the Literature
Birth, 2007
Background: The cesarean section rate continues to rise in many countries with routine access to medical services, yet this increase is not associated with improvement in perinatal mortality or morbidity. A large number of commentaries in the medical literature and media suggest that consumer demand contributes significantly to the continued rise of births by cesarean section internationally. The objective of this article was to critically review the research literature concerning women's preference or request for elective cesarean section published since that critiqued by Gamble and Creedy in 2000. Methods: A search of key databases using a range of search terms produced over 200 articles, of which 80 were potentially relevant. Of these, 38 were research-based articles and 40 were opinion-based articles. A total of 17 articles fitted the criteria for review. A range of methodologies was used, with varying quality, making meta-analysis of findings inappropriate, and simple summaries of results difficult to produce. Results: The range and quality of studies had increased since 2001, reflecting continuing concern. Women's preference for cesarean section varied from 0.3 to 14 percent; however, only 3 studies looked directly at this preference in the absence of clinical indications. Women's preference for a cesarean section related to psychological factors, perceptions of safety, or in some countries, was influenced by cultural or social factors. Conclusions: