An institutional study of cesarean delivery on maternal request

A. Shanti Sri, Nazia Khanam


Background: Cesarean delivery on maternal request refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of a standard medical/obstetrical indication for avoiding vaginal birth. The aim of the study was to find out the reasons behind, and the incidence of women preferring Cesarean section in the absence of obstetric and medical indications.

Methods: This was a prospective study among women who came for delivery at Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, over a period of one year from 1st April 2015 to 31st March 2016. All women who underwent Cesarean delivery for maternal request were included in this study.

Results: The total number of deliveries during the study period of one year was 2574. There were 1346 (52.29%) vaginal deliveries and 1228 (47.7%) cesarean deliveries. Among 1228 Cesarean deliveries, 87 (7.08%) had maternal request as their indication. Majority of them were in the age group of more than 35 years. Multigravidae opted for Cesarean delivery more than primigravidae (59 multigravidae vs 28 primigravidae). Among the various reasons for women requesting delivery cesarean were tocophobia, refusal of trial of labor after Cesarean section (TOLAC), concurrent sterilization, prolonged infertility and treatment conception, afraid of neonatal outcome (previous adverse neonatal outcome) and astrological concerns.

Conclusions: Many of the women opted for Cesarean delivery in our study for preventable reasons like painless labor and concurrent sterilization which would have been easily avoided by prior counseling starting from antenatal period and by providing labor analgesia. Patient education and personal involvement of the treating obstetrician in counseling the patient and emotional support during labor can reduce Cesarean delivery for maternal request.


Cesarean section, Maternal request, Tocophobia, Vaginal deliveries

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Sahlin M, Carlander-Klint AK, Hildingsson I, Wiklund I. First-time mothers' wish for a planned caesarean section: deeply rooted emotions. Midwifery. 2013;29(5):447-52.

Wlklund I, Andolf E, Lilja H, Hildingson I. Indications for caesarean section on maternal request - Guidelines for counselling and treatment. Sexual Reprod Health Care. 2012;3:99-106.

National Institutes of Health State-of-the-Science Conference Statement. Cesarean Delivery on Maternal Request. Obstet Gynecol. 2006;107:1386-97.

RCOG Clinical Effectiveness Support Unit. The National Sentinel Caesarean Section Audit Report. London: RCOG Press;2001.

Al-Mufti R, McCarthy A, Fisk NM. Survey of obstetricians′ personal preference and discretionary practice. Eur J Obstet Gynecol Reprod Biol. 1997;73:1-4.

Helal AS, Abdel-Hady ES, Refaie E, Warda O, Goda H, Sherief LS. Rising rates of caesarean delivery at Mansoura University hospital: a reason for concern. Gynecol Obstet. 2013;3:146.

WHO. Monitoring obstetric care: a handbook. Geneva: WHO Press, World Health Organization, 2009.

Chu K, Cortier H, Maldonado F, Mashant T, Ford N, Trelles M. Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres. PLoS One. 2012;7:e44484.

Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41:237-44.

Nerum H, Halvorsen L, Sorlie T, Oian P. Maternal request for caesarean section due to fear of birth: can it be changed through crisis oriented counselling? Birth. 2006;33:221-8.

Paterson-Brown S, Fisk NM. Caesarean section: every woman's right to choose? Curr Opin Obstet Gynecol. 1997;9(6):351-5.

National Institutes of Health. NIH State of the science Conference statement on Cesarean delivery on maternal request. Bethesda. 2006:1-29.

Agency for Healthcare Research and Quality. Cesarean Delivery on Maternal Request. 2006.

Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-32.

D'Souza R, Arulkumaran S. To 'C' or not to 'C'? Caesarean delivery upon maternal request: a review of facts, figures and guidelines. J Perinat Med. 2013;41(1):5-15.

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 559: Cesarean delivery on maternal request. Obstet Gynecol. 2013;121(4):904-7.