J Korean Matern Child Health .  2024 Apr;28(2):42-50. 10.21896/jkmch.2024.28.2.42.

Changes in the Cesarean Section Rate Following the Implementation of Guidelines Concerning Cesarean Section on Maternal Request

• KMID: 2555189
• DOI: http://doi.org/10.21896/jkmch.2024.28.2.42

Abstract

Traditionally, cesarean delivery on maternal request (CDMR) has been defined as a cesarean section performed at the request of the pregnant woman rather than for medical necessity. It was thought to provide minimal benefits to both the pregnant woman and the fetus and was seen as an inefficient use of healthcare resources. However, the recent rise in the choice and use of cesarean sections is influenced not only by obstetrical factors but also by psychological and socio-cultural factors of the mother, the desire among medical providers to avoid uncertainty, and the pursuit of time and economic convenience, among other complex factors. In particular, there is a growing trend among medical professionals who prefer cesarean sections to avoid costly medical lawsuits. However, if a pregnant woman opts for an elective cesarean section due to the convenience of medical professionals or fear of litigation, even if she prefers a vaginal delivery, it would be considered an unnecessary cesarean section. When a pregnant woman desires CDMR, medical professionals should thoroughly explain the advantages and disadvantages of both attempting vaginal delivery and CDMR so that she can make an informed decision. Nevertheless, if a pregnant woman still chooses a cesarean section after being fully informed, her autonomy should be respected. In such cases, it is recommended that medical practitioners use a minimally invasive surgical method, along with appropriate preoperative and postoperative care, to reduce the morbidity of both the mother and infant and to support a rapid recovery.

Reference

American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine., Caughey AB., Cahill AG., Guise JM., Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014. 210:179–93.

Barrett JF., Hannah ME., Hutton EK., Willan AR., Allen AC., Armson BA, et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med. 2013. 369:1295–305.

Begum T., Saif-Ur-Rahman KM., Yaqoot F., Stekelenburg J., Anuradha S., Biswas T, et al. Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression. BJOG. 2021. 128:798–806.

Bertoli P., Grembi V., Llaneza Hesse C., Vall Castelló J. The effect of budget cuts on C-section rates and birth outcomes: Evidence from Spain. Soc Sci Med. 2020. 265:113419.

Betran AP., Ye J., Moller AB., Souza JP., Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021. 6:e005671.

Cho CE., Norman M. Cesarean section and development of the immune system in the offspring. Am J Obstet Gynecol. 2013. 208:249–54.

Cho Y., Kim YM. Gender ideology and fertility intentions amid the changing breadwinner model: a mixed method approach. Korea J Popul Stud. 2020. 43:69–97. https://doi.org/10.31693/kjps.2020.12.43.4.69.

Chung SH., Seol HJ., Choi YS., Oh SY., Kim A., Bae CW. Changes in the cesarean section rate in Korea (1982-2012) and a review of the associated factors. J Korean Med Sci. 2014. 29:1341–52.

Committee on Obstetric Practice. ACOG Committee Opinion No. 761: Cesarean Delivery on Maternal Request. Obstet Gynecol. 2019. 133:e73–7.

Dhakal-Rai S., Van Teijlingen E., Regmi PR., Wood J., Dangal G., Dhakal KB. A brief history and indications for cesarean section. JPAHS. 2021. 8:101–11. https://doi.org/10.3126/jpahs.v8i3.27657.

Ecker J. Elective cesarean delivery on maternal request. JAMA. 2013. 309:1930–6.

Facchini G. Low staffing in the maternity ward: keep calm and call the surgeon. J Econ Behav Organ. 2022. 197:370–94. https://doi.org/10.1016/j.jebo.2022.03.013.

Garthus-Niegel S., von Soest T., Knoph C., Simonsen TB., Torgersen L., Eberhard-Gran M. The influence of women's preferences and actual mode of delivery on posttraumatic stress symptoms following childbirth: a population-based, longitudinal study. BMC Pregnancy Childbirth. 2014. 14:191.

Gregory KD., Jackson S., Korst L., Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol. 2012. 29:7–18.

Guo Y., Murphy MSQ., Erwin E., Fakhraei R., Corsi DJ., White RR, et al. Birth outcomes following cesarean delivery on maternal request: a population-based cohort study. CMAJ. 2021. 193:E634–44.

Habiba M., Kaminski M., Da Frè M., Marsal K., Bleker O., Librero J, et al. Caesarean section on request: a comparison of obstetricians’ attitudes in eight European countries. BJOG. 2006. 113:647–56.

Hankins GD., Clark SM., Munn MB. Cesarean section on request at 39 weeks: impact on shoulder dystocia, fetal trauma, neonatal ence-phalopathy, and intrauterine fetal demise. Semin Perinatol. 2006. 30:276–87.

Hannah ME., Hannah WJ., Hewson SA., Hodnett ED., Saigal S., Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000. 356:1375–83.

Hoxha I., Syrogiannouli L., Luta X., Tal K., Goodman DC., da Costa BR, et al. Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis. BMJ Open. 2017. 7:e013670.

Huang L., Chen Q., Zhao Y., Wang W., Fang F., Bao Y. Is elective cesarean section associated with a higher risk of asthma? A meta-analysis. J Asthma. 2015. 52:16–25.

Jenabi E., Khazaei S., Bashirian S., Aghababaei S., Matinnia N. Reasons for elective cesarean section on maternal request: a systematic review. J Matern Fetal Neonatal Med. 2020. 33:3867–72.

Keag OE., Norman JE., Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018. 15:e1002494.

Kim AM., Park JH., Kang S., Yoon TH., Kim Y. An ecological study of geographic variation and factors associated with cesarean section rates in South Korea. BMC Pregnancy Childbirth. 2019. 19:162.

Kim KH., Lee JC., Moon SJ. Survey of awareness of essential medical care and medical issues among medical students. Seoul (Korea): Research Institue for Healthcare Policy;2023.

Liu X., Landon MB., Cheng W., Chen Y. Cesarean delivery on maternal request in China: what are the risks and benefits? Am J Obstet Gynecol. 2015. 212:817.e1–9.

Localio AR., Lawthers AG., Bengtson JM., Hebert LE., Weaver SL., Brennan TA, et al. Relationship between malpractice claims and cesarean delivery. JAMA. 1993. 269:366–73.

Maeda E., Ishihara O., Tomio J., Sato A., Terada Y., Kobayashi Y, et al. Cesarean section rates and local resources for perinatal care in Japan: a nationwide ecological study using the national database of health insurance claims. J Obstet Gynaecol Res. 2018. 44:208–16.

Mossialos E., Allin S., Davaki K. Analysing the Greek health system: a tale of fragmentation and inertia. Health Econ. 2005. 14(Suppl 1):S151–68.

Mullman L., Hilden P., Goral J., Gwacham N., Tauro C., Spinola K, et al. Improved outcomes with an enhanced recovery approach to Cesarean delivery. Obstet Gynecol. 2020. 136:685–91.

National Institutes of Health state-of-the-science conference state-ment: Cesarean delivery on maternal request March 27-29, 2006. Obstet Gynecol. 2006. 107:1386–97.

Olieman RM., Siemonsma F., Bartens MA., Garthus-Niegel S., Scheele F., Honig A. The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy Childbirth. 2017. 17:195.

Penna L., Arulkumaran S. Cesarean section for non-medical reasons. Int J Gynaecol Obstet. 2003. 82:399–409.

Prior E., Santhakumaran S., Gale C., Philipps LH., Modi N., Hyde MJ. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012. 95:1113–35.

Ramasauskaite D., Nassar A., Ubom AE., Nicholson W; FIGO Childbirth and Postpartum Hemorrhage Committee. FIGO good practice recommendations for cesarean delivery on maternal request: Challenges for medical staff and families. Int J Gynaecol Obstet. 2023. 163(Suppl 2):10–20.

Rana T., Satwah S., Bellussi F., Berghella V. Obstetrical provider preferences for cesarean delivery on maternal request in uncompli-cated pregnancies: a systematic review of the literature. Am J Obstet Gynecol MFM. 2023. 5:100839.

Sevelsted A., Stokholm J., Bønnelykke K., Bisgaard H. Cesarean section and chronic immune disorders. Pediatrics. 2015. 135:e92–8.

Suwanrath C., Chunuan S., Matemanosak P., Pinjaroen S. Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand. BMC Pregnancy Child birth. 2021. 21:23.

Trahan MJ., Czuzoj-Shulman N., Abenhaim HA. Cesarean delivery on maternal request in the United States from 1999 to 2015. Am J Obstet Gynecol. 2022. 226:411.e1–411.e8.

Uyanıklar ÖÖ., Türk P., Aslan K., Aslan EK., Özden O., Gürlüer J, et al. How does the ERAS protocol work in patients who underwent cesarean section? (HERMES study). Int J Gynaecol Obstet. 2023. 161:168–74.

Vimercati A., Greco P., Kardashi A., Rossi C., Loizzi V., Scioscia M, et al. Choice of cesarean section and perception of legal pressure. J Perinat Med. 2000. 28:111–7.

Visser GHA., Ayres-de-Campos D., Barnea ER., de Bernis L., Di Renzo GC., Vidarte MFE, et al. FIGO position paper: how to stop the caesarean section epidemic. Lancet. 2018. 392:1286–7.

World Health Organization Human Reproduction Programme, 10 April 2015. WHO Statement on caesarean section rates. Reprod Health Matters. 2015. 23:149–50.

Xie RH., Lei J., Wang S., Xie H., Walker M., Wen SW. Cesarean section and postpartum depression in a cohort of Chinese women with a high cesarean delivery rate. J Womens Health (Larchmt). 2011. 20:1881–6.

Zbiri S., Rozenberg P., Goffinet F., Milcent C. Cesarean delivery rate and staffing levels of the maternity unit. PLoS One. 2018. 13:e0207379.

Zhang J., Landy HJ., Ware Branch D., Burkman R., Haberman S., Gregory KD, et al. 2010. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010. 116:1281–7. https://doi.org/10.1097/AOG.0b013e3181fdef6e.