Abstract
A maternal request for an elective CS in the absence of a maternal or fetal indication
may raise risk-benefit considerations and ethical concerns for a health care provider.
Appropriate counselling of the patient on the risks and benefits in proceeding with
a CDMR without medical indication is essential. Providers should have a clear knowledge
of the risks and benefits of providing an elective CS without medical indications
compared to the risks and benefits of supporting an attempt at vaginal delivery, so
that the patient may reach an informed decision. The principle of patient autonomy
should be respected but other ethical principles (beneficence, non-maleficence and
justice) need to be taken into consideration during the counselling process. There
are no studies to estimate maternal and neonatal risks in CDMR. Often studies on CS
before the onset of labour are used as surrogates to determine risks and benefits.
After exploring the reasons behind the patient's request, and discussing the risks
and benefits, if a patient insists on her choice a physician may pursue one of the
following two options: 1) Agree to perform the CS after 39+0 weeks gestation; 2) Disagree
and refer the patient for a second opinion.
Key Words
Abbreviations:
CI (confidence interval), CDMR (Caesarean delivery on maternal request), CS (Caesarean section), MHP (maternal health provider), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
No. 361, July 2018
Footnotes
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
Patients have the right and responsibility to make informed decisions about their care in partnership with their health care providers. To facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate, and tailored to their needs. The values, beliefs, and individual needs of each patient and their family should be sought, and the final decision about the care and treatment options chosen by the patient should be respected.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
