An independent panel convened by the National Institutes of Health announced today that the available information comparing the risks and benefits of Caesarean delivery on maternal request (CDMR) versus planned vaginal birth do not provide the basis for a recommendation in either direction.

The panel defined CDMR as a Caesarean delivery for a pregnancy with a single baby at the mother's request when she has no established medical indication for the procedure. CDMR is a subset of elective Caesarean delivery, and distinct from both emergency Caesarean delivery and Caesarean performed following attempted vaginal delivery.

Potential benefits of CDMR as compared with planned vaginal delivery include a decreased risk of hemorrhaging for the mother, and a reduced risk of certain birth injuries for the baby. Potential risks of CDMR include an increased risk of respiratory problems for the baby and a longer maternal hospital stay.
The panel added that each woman requesting CDMR deserves individualized counseling regarding the potential risks and benefits of both vaginal and Caesarean delivery. When counseling patients, providers should also consider such factors as societal and cultural conventions, ethical issues, available resources, and other factors pertaining to the individual patient.

Panel members did find evidence to suggest caution in certain situations. They concluded that CDMR should be avoided for women desiring large families. This is because the risk of serious complications for subsequent pregnancies increases with each additional Caesarean delivery.

The panel further stressed 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.

In its report, the panel also expressed concern that a woman might choose a Caesarean delivery because effective pain management would not be available at the facility in which she would give birth.

"CDMR should not be motivated by unavailability of effective pain management," the panel wrote. "Efforts must be made to assure availability of pain management services for all women."

To address the weaknesses they identified in the available scientific literature, the panel made a variety of recommendations for future research, including:

* Surveys of women (before and after birth), providers, insurers, and health care facilities regarding CDMR,

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