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Panel Finds Insufficient Evidence to Recommend
For or Against Maternal-Request Caesarean Delivery
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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. Doctor 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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| Date: 03/29/2006 |
Reporter:
Bill Schmalfeldt |
Sound
Bite:
Dr. Mary E. D'Alton |
Topic:
Caesarean Delivery |
| Institute(s): NICHD; OMAR |
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