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JOGC

No. 361-Caesarean Delivery on Maternal Request

      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)
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