A Review of Issues Surrounding Medically Elective Cesarean Delivery

Abstract

The rate of cesarean delivery has increased dra matically over the past decade. Medically elective cesareans are a major factor contributing to this rise. This article discusses the most recent evidence on the perinatal risks of cesarean delivery versus vaginal birth, the economic impact of elective cesarean delivery, and ethical principles related to cesareans performed without medical indication. Physicians ' rationales and responses to the issues are reviewed and the recommendations and guidelines of professional organizations are summarized. Available evidence does not lend support to a current shift in clinical practice. Research is needed to adequately compare outcomes of planned cesarean delivery and planned vaginal birth. Until evidence supports medically elective cesarean as a birth option that optimizes outcomes for low-risk mothers and their infants, obstetric care providers should continue to support evidenced-based decision making that includes advocacy for vaginal delivery as the optimal mode of birth. JOGNN , 36, 605-615;

Mode of Delivery and Breastfeeding Practices

“…It is known that mothers with a c-section tend to experience longer recovery periods and more medical problems. 16,24,25 Because of this, it is essential that healthcare providers start conversations around breastfeeding during the prenatal period, when a c-section may be planned. Discussions around infant feeding practices should be addressed not only with the mothers, but also with the immediate family members who might serve as a mechanism of support.…”

“…Several sociodemographic characteristics were used to describe the sample, including mother's age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), and >34 years old), mother's education (high school or less, some college, 4-year college or more) and marital status (married, widowed/divorced/ separated, never married). Prenatal smoking (non-smoker, smoker) and prepregnancy BMI (<19.8 underweight, 19.8 to ≤26 normal, >26 to ≤29 overweight, and >29 obese).…”

Attitudes of Obstetricians toward Cesarean Delivery in Challenging Cases

“…Although there are common indications for performing cesarean delivery, including fetal stress, failure to progress, previous cesarean, and breech [6], maternal request appears to be the strongest factor [7][8][9]. However, how obstetricians are influenced by maternal request has not yet been robustly explained.…”

Review of Cesarean Section on Maternal Request in a Tertiary Care Institute; Scenario in Developing Country

“…22 There are a number of surgical complications reported related to cesarean delivery they are damage to the bladder, ureters, laceration of the uterine artery and other abdominal structures. 23 Pulmonary embolism remains a leading cause of maternal mortality is far more likely to occur following a caesarean section. There is evidence of decreased fecundity, increased risk of ectopic pregnancies, placenta previa and worse infant outcome in future pregnancy.…”

“…In addition, blood loss for a healthy woman after a vaginal delivery is estimated at 500 ml in comparison to 1,000 ml for a cesarean delivery, thus increasing the possible need for a blood transfusion during the postpartum period. 23 The literature reviewed defines postpartum hemorrhage as having a blood loss of more than 500 ml after delivery.…”