Caesarean delivery by Maternal Request (CDMR)

1Copyright © 2014 Paras Hospitals. All rights reserved.

Caesarean Section By Choice: A Primary Elective Caesarean Birth

Dr Nupur Gupta

Dr Monika Choudhary

Dr Manjiri Deshpande

Dept of Obstetrics & Gynecology

Paras Hospital, Gurgaon


CAESAREAN BY CHOICE(CDMR)

Caesarean delivery on maternal

request

Caesarean section birth, requested by

the pregnant woman without a

medical reason


CDMR

Maternal request becoming

increasingly common

Earlier not well recognized


CDMR

There are Controversies

Focus of attention both for clinical &

ethical reasons

Cesarean section on demand

is unethical--- FIGO 1999


It is ethically permissible to request for an elective Cesarean

from an informed woman—

but it is also acceptable to refuse if the surgeon feels it is not in

the woman’s interest.

----ACOG 2003

CDMR


Vaginal birth remains the “preferred” approach

and the safest option for most women and carries

with it less risk of complications in pregnancy and

subsequent pregnancies than Cesarean births…

CDMR

SOGC March 2004

promote natural childbirth through

childbirth education


Prevalence of CDMR

1 to 18 percent of all Caesarean

deliveries worldwide,

1 to 3 percent of all Caesarean

deliveries in the US


WHO – 10 TO 15%

UK – 25%

US – 33%

BRAZIL - > 50%

Worldwide Incidence


Difference- Elective CS & CDMR

An elective caesarean section done on

the basis of some medical conditions

CDMR - mother's preference for the

delivery mode


Reasons for CDMR

Mother’s choice

Woman's personal philosophy about childbirth

Fear of vaginal delivery/PAIN

Previous CS

Previous traumatic vaginal delivery or childbirth

experience

Previous intrapartum death of fetus


Factors influencing CDMR rate

Doctor’s age

Total years of experience

Involvement in private practice &

research

Unit’s annual delivery rate

Number of obstetric beds

Unit’s CS rate

Whether the unit is referral Centre

for high risk pregnancies or not

12Copyright © 2014 Paras Hospitals. All rights reserved. 12

Increasing Incidence………..

Safer anesthesia practices

Fear of labour pain

Improved techniques


Survey of Doctors

Obstetricians, Urogynecologists &

Colorectal surgeons

Preference for cesarean by request for

themselves and their family members


Potential Benefits of CDMRPlanned

timing of birth


Initiation of Breastfeeding – Late

More chances of neonatal respiratory

complications

Anaesthesia

Surgery related

Disadvantages of CDMR


Risk Ratio

Emergency Caesarean– 16 %

Instrumental Vaginal Delivery - 13 %

Elective Caesarean- 7 %


Min gestation should be 39 weeks or more

Or till lungs are mature

When to undergo

CDMR?


LABOR AND DELIVERY:

IT’S NOT ALWAYS WHAT

YOU EXPECTED


Be prepared for anything! It’s wonderful to have a birth plan but be prepared for the possibility of an alternate route. Try not to get caught up in the disappointment and take in every moment. I had a C-section, and I am no less of a mom than a woman who delivered naturally. That may not be the path I chose, but it is the path I was given. I have not only accepted it, but embraced it. I feel like it has even made me a stronger woman!

Patient experiences……about Caesarean


More Research is needed in future……


To promote safe, effective and satisfying

maternity care for all women and their families through

research, education , expertise and advocacy

Mission


We individualize every patient

We follow ethical principles

Efficient, highly skilled team of doctors,

technicians & paramedical staff

Manage high risk cases

Our USP


Your needs: Our priority

Excellent teamwork

Well equipped infrastructure with quality care

Patient friendly environment

Blood Bank facility

Neonatal ICU facility

Our USP

Healthcare

Caesarean delivery by Maternal Request (CDMR)