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Evidence Library · Choice and consent

Asking for a cesarean when there is no medical reason

It is permitted. It is not recommended by default.

Some women ask for a cesarean without a medical indication. Guidance from ACOG states that when there is no maternal or fetal reason for surgery, a plan for vaginal delivery is safe and appropriate and should be recommended.

If a cesarean is nevertheless chosen, guidance is that it should not be done before 39 weeks, and that the woman should be counseled that placenta previa, placenta accreta spectrum and hysterectomy risks all rise with each subsequent cesarean, taking into account how many children she plans to have.

Guidance also states that when the request is driven by fear of labor pain, the response should be to discuss and offer labor analgesia, childbirth education and emotional support, rather than to proceed straight to surgery.

A 2006 national consensus panel concluded that the evidence is insufficient to fully weigh the benefits and risks of a requested cesarean against planned vaginal birth. That is still where the evidence stands.

Where this comes from:
343. American College of Obstetricians and Gynecologists. Cesarean delivery on maternal request. ACOG Committee Opinion No. 761. Obstet Gynecol. 2019;133(1):e73-e77.
344. National Institutes of Health. NIH State-of-the-Science Conference Statement: cesarean delivery on maternal request. Obstet Gynecol. 2006;107(6):1386-1397.

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