Elective cesarean: honor her choice.(C-section on maternal request)

WASHINGTON -- Any decision between cesarean delivery by maternal request or trial of labor ultimately lies with the woman, once the potential risks and benefits associated with C-section have been discussed, concluded an independent panel of experts on cesarean section.

"Her decision should be honored," said Dr. Mary E. D' Alton, panel chairperson, speaking at a conference on cesarean delivery sponsored by the National Institutes of Health.

The panel, convened to assess the state of the science regarding cesarean delivery on maternal request, or elective cesarean, concluded that the available information on its risks and benefits vs. planned vaginal birth do not provide the basis for a recommendation in either direction.

The panel defined C-section on maternal request as a mother's request for a cesarean delivery for a singleton pregnancy when she has no established medical indication for the procedure. They noted that C-section on maternal request is distinct from emergency C-section or C-section performed following attempted vaginal delivery.

"We don't believe [C-section on maternal request] should be discouraged or encouraged. We believe there should be a full discussion of the risks and benefits as we know them right now," said Dr. D'Alton, also chair of the department of obstetrics and gynecology at Columbia University in New York.

Although it's difficult to assess the prevalence of cesarean delivery by maternal request, many believe the rate to be increasing, with domestic and international estimates ranging from 4% to 18% of all cesarean deliveries. In 2004, almost one-third (29%) of all live births in the United States were by C-section, the highest rate ever reported.

The panel advised physicians to engage in nondirective counseling when a woman requests a C-section without a medical indication. "After thorough discussion and review, [cesarean delivery on maternal request] may be a reasonable alternative to [planned vaginal delivery]. When a provider cannot support this request, it is appropriate to refer the woman to another provider," the panel said in a draft state-of-the-science conference statement.