What are the ACOG and NIH guidelines on elective cesarean delivery on maternal request (CDMR)?

Updated: Dec 14, 2018
  • Author: Hedwige Saint Louis, MD, MPH, FACOG; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Controversy exists regarding elective cesarean delivery on maternal request (CDMR). The 2013 American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice [9] and 2006 National Institutes of Health (NIH) consensus committee [10] determined that the evidence supporting this concept was not conclusive and that more research is needed.

Both committees provided the following recommendations regarding CDMR [9, 10] :

  • Unless there are maternal or fetal indications for cesarean delivery, vaginal delivery should be recommended

  • CDMR should not be performed before 39 weeks’ gestation without verifying fetal lung maturity (due to a potential risk of respiratory problems for the baby)

  • CDMR is not recommended for women who want more children (due to the increased risk for placenta previa/accreta and gravid hysterectomy with each cesarean delivery)

  • The inavailability of effective analgesia should not be a determinant for CDMR

The NIH consensus panel on CDMR also noted the following [10] :

  • CDMR has a potential benefit of decreased risk of hemorrhage for the mother and decreased risk of birth injuries for the baby

  • CDMR requires individualized counseling by the practitioner of the potential risks and benefits of both vaginal and cesarean delivery


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