The obstetrician's perspective on cesarean section on maternal request

Percentages of cesarean section world-wide have increased substantially over the past two decades. Maternal request for abdominal delivery may have contributed to this development. The wish to be delivered by C-section for personal reasons without medical indication should be discussed from the medical point of view as well as from the legal perspectives of mother and child. Today, mortality in primarily indicated and performed cesarean section is not substantially higher than in vaginal delivery. The consequences of cesarean section are important for succeeding pregnancies. Besides the risk of scar rupture, the drastic increase in the incidences of placental detachment (placenta accreta/increta/percreta) and placenta previa in succeeding pregnancies are of relevance. However, this risk should be weighed against fetal risk in vaginal delivery, especially intrauterine death and encephalopathy caused by intrapartum hypoxia as well as cerebral palsy amounting to 1/500. Pelvic floor damage after vaginal delivery can probably be reduced but not necessarily avoided by primary cesarean section. In summary, advantages and disadvantages of vaginal and abdominal delivery have to be weighed up carefully. Cesarean section performed by an experienced team with optimal equipment is accompanied by rather low risk. The obstetrician has to consider possible unlawfulness in cases of maternal request for cesarean section.