NIH Radio
Panel Finds Insufficient Evidence to Recommend For or Against Maternal-Request Caesarean Delivery
Brief Description:
An independent panel convened by the National Institutes of Health announced that the available information comparing the risks and benefits of caesarean delivery on maternal request — otherwise known as CDMR — versus planned vaginal birth do not provide the basis for a recommendation in either direction.
Transcript:
Schmalfeldt: An independent panel convened by the National Institutes of Health announced that the available information comparing the risks and benefits of caesarean delivery on maternal request " otherwise known as CDMR " versus planned vaginal birth do not provide the basis for a recommendation in either direction. The Panel, convened by the National Institute of Child Health and Human Development and the Office of Medical Applications of Research, defined CDMR as a caesarean delivery for a singleton pregnancy at the mother's request when she has no established medical indication for the procedure. Dr. Mary E. D'Alton of Columbia University was the panel chair. She outlined the findings of the conference at an NIH press conference.
D'Alton: We found that the incidence of caesarean delivery without medical and obstetrical indication is rising in the United States, and a component of this is due to caesarean delivery by maternal request. Given the current tools that are available, the magnitude of caesarean delivery by maternal request is difficult to quantify. There is insufficient evidence at this time to fully evaluate the benefits and risks of caesarean delivery by maternal request as compared to planned vaginal delivery, and more research is needed. Until quality evidence becomes available, any decision to perform a caesarean delivery on maternal request should be carefully individualized and consistant with ethical principles. Given the risks that placentia previa and accrete rise with each caesarean delivery, caesarean delivery on maternal request is not recommended for women desiring several children. Caesarean delivery on maternal request should not be performed prior to thirty-nine weeks or without verification of lung maturity, because of the significant danger of neonatal respiratory complications. Request for caesarean delivery on maternal request should not be motivated by unavailability of effective pain management. Efforts must be made to assure availability of pain management services for all women in this country. And NIH or other federal agency, we believe, should establish and maintain a web site to provide up-to-date information on the benefits and risks of all modes of delivery.
Schmalfeldt: According to the draft statement issued by the panel, potential benefits of CDMR include a decreased risk of hemorrhaging for the mother, and a reduced risk of certain birth injuries for the baby. Potential risks of CDMR include a longer hospital stay and increased risk of respiratory problems for the baby. To address the weaknesses they identified in the available scientific literature, the Panel made a variety of recommendations for future research, including: Surveys of women (before and after birth), providers, insurers, and health care facilities regarding CDMR, A thorough assessment of the costs of CDMR, Establishment of uniform documentation of CDMR, to accurately reflect prevalence of the procedure, Examination of existing large databases to assess incidence of various complications, including rare but critical outcomes, and Development of strategies to predict and influence the likelihood of successful vaginal birth. The Panel released its findings on March 29, following two days of expert presentations and panel deliberations. Full text of the Panel's draft state-of-the-science statement is available at http://consensus.nih.gov. The final version will be available at the same Web address in three to four weeks. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
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