Cesarean delivery on maternal request: a western North Carolina perspective

Cesarean delivery on maternal request (CDMR), a primary cesarean without medical indication for a singleton, term pregnancy, has been identified by physicians as one factor in the increasing rate of cesarean delivery despite nationwide efforts to the contrary. The purpose of this project was to better understand women's preferences and motivations for their desired mode of delivery. A 62-item survey was administered to pregnant women asking for their delivery preference, their reasons, sources of information, feelings about this pregnancy, and opinions about delivery options. Responses were analyzed for candidates for CDMR or for repeat cesarean section, separately; the standard error of measure is ±4% (95% CI). 396 patients returned surveys (response rate = 63.2%). CDMR was desired by 34/316 (11%) candidates; repeat cesarean was desired by 32/70 (46%) patients. Significant correlates of CDMR included choosing during the first trimester (22% vs. 8.2%; RR = 2.72; P = 0.015), smoking during pregnancy (19.7% vs. 7.6%; RR = 2.60; P = 0.036), and being worried about the delivery (P = 0.004). Desire for CDMR increased as worries increased from unworried (4.4%) to somewhat (11.8%) to very worried (27.6%). Primary reasons included existing medical complications and preventing birth injury. The majority of patients believed CDMR should be an "informed choice"; other opinions varied by delivery preference. The majority of women preferred vaginal deliveries suggesting little contribution of CDMR to the increasing cesarean rate. Contrary to physicians' beliefs, the women's primary objective was their infants' health rather than their own well-being.