Cesarean Delivery on Maternal Request - Information for Women

Fact sheet

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Cesarean delivery is a surgical procedure that can be a life saver for both mother and baby.  Cesarean delivery can be planned (elective) or done as an emergency procedure. Planned cesarean may be indicated in particular medical situations such as a serious health condition in the mother or certain positions of the placenta or baby. It may also be indicated if the mother has had a previous cesarean delivery. 

The rate of cesarean delivery in Canada is on the rise. There are concerns that this increase is due partly to more women requesting the procedure without clear medical indications. Women may request cesarean delivery due to a perception that it is an easy and risk-free alternative to vaginal delivery. However, there is evidence, including research from Canada, that this is not the case.

The Canadian Perinatal Surveillance System carried out a study on the risks of cesarean delivery. The study, published in the CMAJ, is entitledMaternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.

There is a lack of data on cesarean delivery purely on the basis of maternal request. Therefore, to obtain information about the risks of the procedure itself, without existing medical conditions that might affect health outcomes for the mother, the study authors analyzed data on healthy women having a planned cesarean delivery for breech presentation. They compared outcomes for these women to outcomes for healthy women with planned vaginal delivery.

Overall, the women having a cesarean delivery had three times the rate of severe illness after delivery compared to the women with planned vaginal delivery. They also stayed longer in hospital, on average. The chart below compares rates of specific maternal outcomes for the two groups.

click on the image to enlarge

It is important to emphasize that in certain circumstances cesarean delivery will be the safest approach for mother and baby. 

However, as the study shows, planned cesarean delivery in healthy women brings increased risks to the health of the mother. Women and their health care providers who are contemplating a cesarean delivery only because of maternal request are encouraged to talk openly about potential risks, and about fears and concerns regarding childbirth, including pain.

Also, while these study results show increased risks for the mother, the actual number of women affected is small. In Canada, we are fortunate that there is a high level of safety for women giving birth, by whatever means, due to excellent health care and health facilities. 

Additional Resources:

• Your Health Care Provider

• National Institutes of Health Consensus Development Program