Position statement adopted June 6, 2006

“Citizens for Midwifery supports the rights of women to autonomy and bodily integrity regarding maternity care and birthing choices.  Such choices should be made in the context of full disclosure and honest, unbiased and complete informed consent processes, which are rarely provided for cesarean sections.  Cesarean sections for no medical indication, by “maternal request” or not, add serious risks, unnecessarily use scarce and costly healthcare resources, and entail extra costs borne by the public.  Citizens for Midwifery supports maternity care that nurtures and enables normal birth with minimal interventions.  For healthy mothers and babies, replacing normal healthy birth with major abdominal surgery almost certainly would have enormous unintended and harmful consequences, and therefore is ill-advised.”

 
Summary of Rationale

Maternal demand for planned primary cesareans with no medical reason is virtually non-existent.
A recent national survey found that fewer than one percent of women who could ask for a primary cesarean section for no medical reason actually do so. Prior research claiming to indicate rising rates of “Patient Choice Cesareans” was based on hospital discharge data which shows only that there has been an increase in cesarean sections performed prior to labor for no recorded medical reason. The hospital data used did not include any information about women’s preferences or choices.

“Cesarean Sections by Maternal Request” are not “as safe as” vaginal birth
When compared to hospital-managed vaginal births, cesarean sections are associated with higher rates of maternal death, hemorrhage, infection, organ injury, re-hospitalization, anesthesia, complications, future, and infertility, as well as slower recovery and poorer health; increased risks for future pregnancies (still births, scar ruptures, life-threatening placenta problems); increased risks to the newborn for respiratory problems leading to NICU admittance; future maternal health risks associated with scar tissue; and decreased rates of breast-feeding initiation and long term breast-feeding success.

• Regarding safety, complications caused by standard medical management of vaginal birth are wrongly attributed to vaginal birth itself, falsely decreasing risk differences between vaginal birth and cesarean section.

• Data shows that cesarean sections do NOT protect against pelvic floor problems, a justification often given for performing elective cesarean sections.
• Research shows that women want informed consent for cesarean sections but are not receiving it.
• Economic and legal factors rather than concern for the health and well-being of mothers and babies are influential in promoting more cesarean sections.
• Attitudinal research has found physicians are biased toward surgical birth; as trusted experts their beliefs influence patient decisions.

Focusing on “Cesarean Section on Maternal Request” diverts attention from the real issue: our country’s astronomically high overall cesarean section rate of 29.1% (2004) and rising. Headlines and government agencies should be asking why obstetricians are performing unnecessary surgery on healthy pregnant women for no medical reason, rather than promoting the fiction of increasing rates of “maternal request” cesareans. 

 For detailed explanations and references see our position statement at <http://www.cfmidwifery.org/Resources/item.aspx?ID=109> entitled “CfM Position on the Issue of “Maternal Request” Cesarean Sections: Ill-Advised for Healthy Normal Mothers and Babies.”