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.
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
“Cesarean Sections by Maternal
Request” are not “as safe as” vaginal birth
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.
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.
shows that cesarean sections do NOT protect against pelvic floor problems, a
justification often given for performing elective cesarean sections.
shows that women want informed consent for cesarean sections but are not
and legal factors rather than concern for the health and well-being of mothers
and babies are influential in promoting more cesarean sections.
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”
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.”