FOR IMMEDIATE RELEASE
Wednesday, March 29, 2006
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Panel Finds Insufficient Evidence to Recommend For or Against
Maternal-Request Caesarean Delivery
Women requesting a Caesarean delivery should be thoroughly counseled on
potential risks and benefits
An independent panel convened by the National Institutes of Health announced
today that the available information comparing the risks and benefits of
Caesarean delivery on maternal request (CDMR) versus planned vaginal birth
do not provide the basis for a recommendation in either direction.
The panel defined CDMR as a Caesarean delivery for a pregnancy with a single
baby at the mother’s request when she has no established medical indication
for the procedure. CDMR is a subset of elective Caesarean delivery, and
distinct from both emergency Caesarean delivery and Caesarean performed
following attempted vaginal delivery.
Potential benefits of CDMR as compared with planned vaginal delivery 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 an
increased risk of respiratory problems for the baby and a longer maternal
The panel added that each woman requesting CDMR deserves individualized
counseling regarding the potential risks and benefits of both vaginal and
Caesarean delivery. When counseling patients, providers should also consider
such factors as societal and cultural conventions, ethical issues, available
resources, and other factors pertaining to the individual patient.
Panel members did find evidence to suggest caution in certain situations.
They concluded that CDMR should be avoided for women desiring large
families. This is because the risk of serious complications for subsequent
pregnancies increases with each additional Caesarean delivery.
The panel further stressed that CDMR should not be performed before the 39th
week of pregnancy or without verification that the fetus’ lungs have matured
sufficiently to avoid newborn respiratory complications.
In its report, the panel also expressed concern that a woman might choose a
Caesarean delivery because effective pain management would not be available
at the facility in which she would give birth.
“CDMR should not be motivated by unavailability of effective pain
management,” the panel wrote. “Efforts must be made to assure availability
of pain management services for all women.”
To address the weaknesses they identified in the available scientific
literature, the panel made a variety of recommendations for future research,
Surveys of women (before and after birth), providers, insurers, and health
care facilities regarding CDMR,
Development of strategies to predict and influence the likelihood of
successful vaginal birth,
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
A thorough assessment of the costs of CDMR.
The panel released its findings this morning, following two days of expert
presentations and panel deliberations. Full text of the panel’s draft
state-of-the-science statement will be available late today at
http://consensus.nih.gov. The final version will be available at the same
Web address in three to four weeks. Statements from past conferences and
additional information about the NIH Consensus Development Program are also
available at the Web site, or by calling 1-888-644-2667.
The 18 members of this State-of-the-Science panel were nominated for
selection by peers who were confident that these individuals’ areas of
expertise would significantly contribute to the process of critically
examining scientific evidence on Caesarean section on maternal request. The
panel included educators, researchers, statisticians, and practitiventive
medicine and biometrics, family planning and reproductive physiology, nurse
midwifery, anesthesiology, patient safety, epidemiology, pediatrics,
perinatal medicine, urology, urogynecology, general nursing, inner city
public health sciences, law, psychiatry, and health services research. The
panel was chaired by Mary D’Alton, M.D., chair of the Department of
Obstetrics and Gynecology at Columbia University Medical Center and Chief of
Obstetrics and Gynecology at the New York-Presbyterian Hospital.
In addition to the material presented at the conference by speakers and the
comments and concerns of conference participants presented during discussion
periods, the panel considered pertinent research from the published
literature and the results of a systematic review of the literature
commissioned by the NIH Office of Medical Applications of Research (OMAR).
The systematic review was prepared through the Agency for Healthcare
Research and Quality (AHRQ) Evidence-based Practice Center (EPC) program, at
the RTI International-University of North Carolina Evidence-based Practice
Center. The EPCs develop evidence reports and technology assessments based
on rigorous, comprehensive syntheses and analyses of the scientific
literature, emphasizing explicit and detailed documentation of methods,
rationale, and assumptions.
The panel’s statement is an independent report and is not a policy statement
of the NIH or the federal government. The NIH Consensus Development Program,
of which this conference is a part, was established in 1977 as a mechanism
to judge controversial topics in medicine and public health in an unbiased,
impartial manner. NIH has conducted 118 consensus development conferences,
and 26 state-of-the-science (formerly “technology assessment”) conferences,
addressing a wide range of issues. A backgrounder on the NIH Consensus
Development Program process is available at
The conference was sponsored by the Office of Medical Applications of
Research (OMAR) and the National Institute of Child Health and Human
Development (NICHD). Cosponsors included the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK), the Office of Research on Women’s
Health (ORWH), and the National Institute of Nursing Research (NINR).
Note to Radio Editors: An audio report of the conference results will be
available after 5:00 p.m. today from the NIH Radio News Service by calling
1-800-MED-DIAL (1-800-633-3425) or visiting
The Office of the Director, the central office at NIH, is responsible for
setting policy for NIH, which includes 27 Institutes and Centers. This
involves planning, managing, and coordinating the programs and activities of
all NIH components. The Office of the Director also includes program offices
which are responsible for stimulating specific areas of research throughout
NIH. Additional information is available at http://www.nih.gov/icd/od/.
The National Institutes of Health (NIH) — The Nation's Medical Research
Agency — includes 27 Institutes and Centers and is a component of the U.S.
Department of Health and Human Services. It is the primary federal agency
for conducting and supporting basic, clinical and translational medical
research, and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and its programs,
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