Why do women request elective CD?

  • Jenabi E & al.
  • J Matern Fetal Neonatal Med
  • 27 Feb 2019

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Systematic review of reasons given for requested cesarean delivery (CD).  
  • Reasons are varied and may reflect cultural, institutional, and professional settings.

Why this matters

  • Elective CD upon request raises ethical issues of beneficence and autonomy.
  • Addressing individual fears and providing accurate information during the informed consent process may help dissuade women from elective CD.
  • Although this study is qualitative, it provides some interesting insights into CD by request.

Key results

  • Maternal reasons for elective CD included: 
    • Fear of labor pain, childbirth, fecal passage.
    • Anxiety about fetal injury/death, gynecologic examination, loss of control, lack of support from the staff.
    • Urinary incontinence, pelvic floor and vaginal trauma, clinician suggestion, time of birth, experience of prior bad delivery, previous infertility, infertility, to avoid long labor, emotional aspects, body weight of the infant at birth, and abnormal prenatal examination.
  • Advanced maternal age was the most common demographic leading to a requested CD.
  • Cultural, institutional, professional settings, and type and manner of information provided for informed consent are important for decision-making.

Study design

  • Systematic review (28 studies).
  • Funding: Hamadan University of Medical Sciences.

Limitations

  • Heterogeneity of studies.
  • Data not quantified.

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