* Development of strategies to predict and influence the likelihood of successful vaginal birth,

* Establishment of uniform documentation of CDMR, to accurately reflect prevalence of the procedure,


* Examination of existing large databases to assess incidence of various complications, including rare but critical outcomes, and

* A thorough assessment of the costs of CDMR.

The panel released its findings this morning, following two days of expert presentations and panel deliberations. Full text of the panel's draft state-of-the-science statement will be available late today at http://consensus.nih.gov. The final version will be available at the same Web address in three to four weeks. Statements from past conferences and additional information about the NIH Consensus Development Program are also available at the Web site, or by calling 1-888-644-2667.

The 18 members of this State-of-the-Science panel were nominated for selection by peers who were confident that these individuals' areas of expertise would significantly contribute to the process of critically examining scientific evidence on Caesarean section on maternal request. The panel included educators, researchers, statisticians, and practitioners in obstetrics and gynecology, preventive medicine and biometrics, family planning and reproductive physiology, nurse midwifery, anesthesiology, patient safety, epidemiology, pediatrics, perinatal medicine, urology, urogynecology, general nursing, inner city public health sciences, law, psychiatry, and health services research. The panel was chaired by Mary D'Alton, M.D., chair of the Department of Obstetrics and Gynecology at Columbia University Medical Center and Chief of Obstetrics and Gynecology at the New York-Presbyterian Hospital.

In addition to the material presented at the conference by speakers and the comments and concerns of conference participants presented during discussion periods, the panel considered pertinent research from the published literature and the results of a systematic review of the literature commissioned by the NIH Office of Medical Applications of Research (OMAR). The systematic review was prepared through the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) program, at the RTI International-University of North Carolina Evidence-based Practice Center. The EPCs develop evidence reports and technology assessments based on rigorous, comprehensive syntheses and analyses of the scientific literature, emphasizing explicit and detailed documentation of methods, rationale, and assumptions.

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