Requests for Cesarean
Births may be Reasonable – NIH Panel Gave Both Pros and Cons to CDMR
birth compared to Natural Vaginal Delivery
The National Institutes of Health (NIH) convened a panel to make
available information comparing the risks and benefits of Caesarean
delivery on maternal request (CDMR) versus planned vaginal birth, and
did not provide the basis for a recommendation in either direction. The
panel said that any woman requesting CDMR should receive individualized
counseling regarding the potential risks.
The panel did not include emergency Caesarean delivery and Caesarean
performed following attempted vaginal delivery in their recommendation.
Their recommendations were concerning the elective Caesarean delivery,
not emergency caesarean deliveries.
There are some benefits to CDMR including a reduced risk of hemorrhaging
for the mother, and a reduced risk of certain birth injuries for the
baby. There are potential risks of CDMR though, including an increased
risk of respiratory problems for the baby and a longer maternal hospital
The panel concluded that CDMR should be avoided for women desiring large
families. There could be a risk of serious complications for subsequent
pregnancies with each additional delivery. The NIH panel also said that
CDMR should not be “performed before the 39th week of pregnancy or
without verification that the fetus’ lungs have matured sufficiently to
avoid newborn respiratory complications.”
According to the NIH, some women may choose CDMR because there would not
be effective pain management available at the facility. The panel said
“CDMR should not be motivated by unavailability of effective pain
management. Efforts must be made to assure availability of pain
management services for all women.”
The panel said it may be ''reasonable" for many women to deliver by
caesarean section even without a medical need. They went on to say
there is not enough evidence to assess the risks of ''maternal request"
C-sections compared with natural births, but said that for now doctors
should discuss the known pros and cons with a woman if she brings up the
option, and decide on a patient-by-patient basis.
By Dan Wilson
Books on Pregnancy
Keywords and misspellings: priatal prenatal pre-natal