ACOG committe opinion: Cesarean Delivery on Maternal Request
In a recently released committee opinion document, the ACOG provides recommends for cesarean delivery on maternal request.

"The available information that compared the risks and benefits of cesarean delivery on maternal request and planned vaginal delivery does not provide the basis for a recommendation for either mode of delivery", the authors write in the document.

Cesarean delivery on maternal request is not a well-recognized clinical entity. Few studies directly compare the intended mode of delivery (ie, cesarean delivery on maternal request to planned vaginal delivery). There is no randomized clinical trial that has compared cesarean delivery with trial of labor for singleton term gestations with vertex presentation.

Most of the current knowledge is based on indirect analyses that compare elective cesarean deliveries without labor (ie, cesarean delivery without a specified indication) instead of cesarean delivery on maternal request, to the combination of vaginal, unplanned cesarean, and emergency cesarean deliveries (instead of planned vaginal deliveries). Similarly, data may report on outcomes of actual modes of delivery, but not on outcomes of cesarean delivery on maternal request versus planned vaginal delivery.

The ACOG makes the following recommendations:-

• If a patient’s main motivation to elect a cesarean delivery is a fear of pain in childbirth, obstetrician-gynaecologists and other obstetric care providers should discuss and offer the patient analgesia for labor, as well as prenatal childbirth education and emotional support in labor.

• In the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate and should be recommended.

• After exploring the reasons behind the patient’s request and discussing the risks and benefits, if a patient decides to pursue cesarean delivery on maternal request, the following is recommended:

— In the absence of other indications for early delivery, cesarean delivery on maternal request should not be performed before a gestational age of 39 weeks.

— Given the high repeat cesarean delivery rate, patients should be informed that the risks of placenta previa, placenta accreta spectrum, and gravid hysterectomy increase with each subsequent cesarean delivery.

About ACOG
Founded in 1951, the American College of Obstetricians and Gynecologists is the speciality's premier professional membership organization dedicated to the improvement of women’s health. With more than 58,000 members, the College produces practice guidelines and other educational material.

Note: This list is a brief compilation of some of the key recommendations included in the guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Cesarean-Delivery-on-Maternal-Request
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