Background
The rate of cesarean delivery has increased in the United States over the last several
decades. However, the rate of cesarean delivery on maternal request remains undetermined,
and recent data on cesarean delivery on maternal request are lacking.
Objective
This study aimed to describe the prevalence and temporal trends of cesarean delivery
on maternal request in the United States and characterize the population of women
who elect to undergo a cesarean delivery in the absence of fetal or maternal indications.
Maternal outcomes between women who delivered by cesarean delivery on maternal request
and those who did not were compared.
Study Design
A retrospective cohort study was conducted using data from the Healthcare Cost and
Utilization Project-Nationwide Inpatient Sample from 1999 to 2015. An algorithm based
on International Classification of Diseases, Ninth Revision codes was created to identify
patients who underwent a primary elective cesarean delivery in the absence of fetal
or maternal indications. Maternal characteristics and outcomes between women who delivered
by cesarean delivery on maternal request and those who did not were compared using
descriptive and logistic regression analyses.
Results
Of the 13,698,835 deliveries included throughout the study period, 228,586 were identified
as cesarean delivery on maternal request. Rates of cesarean delivery on maternal request
among all live births increased throughout the study period, from 1% in 1999 to 1.62%
in 2015 (P<.0001). Women who delivered by cesarean delivery on maternal request were more likely
to be >35 years of age, were in the highest income quartile, and have private insurance.
Cesarean delivery on maternal request was associated with an increased risk of venous
thromboembolism (odds ratio, 1.9; 95% confidence interval, 1.8–2.0), myocardial infarction
(odds ratio, 6.3; 95% confidence interval, 3.8–10.4), sepsis (odds ratio, 5.6; 95%
confidence interval, 4.7–6.6), disseminated intravascular coagulation (odds ratio,
2.9; 95% confidence interval, 2.3–3.7), death (odds ratio, 14.5; 95% confidence interval,
11.4–18.6), and prolonged hospital stay (odds ratio, 4.9; 95% confidence interval,
4.8–5.1) and a lower risk of postpartum hemorrhage (odds ratio, 0.7; 95% confidence
interval, 0.7–0.7).
Conclusion
Our findings indicated that cesarean delivery on maternal request accounts for a small
but increasing proportion of all cesarean deliveries in the United States. Cesarean
delivery on maternal request was more prevalent among women with certain demographic
characteristics, indicating that the option of cesarean delivery on maternal request
may be more appealing or more frequently offered to a certain population of women.
Although the overall risk of adverse events is low for individual births, population
effects can result in increased morbidity and mortality. Therefore, the rates of cesarean
delivery on maternal request should be monitored on a national level. Study findings
were limited by the absence of a specific diagnostic code for cesarean delivery on
maternal request.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- ACOG Committee Opinion No. 761: cesarean delivery on maternal request.Obstet Gynecol. 2019; 133: e73-e77
- New CDC report tracks trends in cesarean births and VBACs during the 1990s.(Available at:)
- Births in the United States, 2015.(Available at:)
- Trends in maternal request cesarean delivery from 1991 to 2004.Obstet Gynecol. 2006; 108: 1506-1516
- NIH State-of-the-Science Conference Statement on cesarean delivery on maternal request.NIH Consens State Sci Statements. 2006; 23: 1-29
- No. 361-caesarean delivery on maternal request.J Obstet Gynaecol Can. 2018; 40: 967-971
- ACOG Committee Opinion No. 390, December 2007. Ethical decision making in obstetrics and gynecology.Obstet Gynecol. 2007; 110: 1479-1487
- Healthcare Cost and Utilization Project (HCUP).Agency for Healthcare Research and Quality, 2020 (Available at:)www.hcup-us.ahrq.gov/nisoverview.jspDate accessed: February 1, 2021
- A national estimate of the elective primary cesarean delivery rate.Obstet Gynecol. 2005; 105: 751-756
- Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.CMAJ. 2007; 176: 455-460
- Trial of labor after cesarean in the low-risk obstetric population: a retrospective nationwide cohort study.J Perinatol. 2016; 36: 808-813
- Using administrative data to identify indications for elective primary cesarean delivery.Health Serv Res. 2002; 37: 1387-1401
- Using ICD-9 codes to identify indications for primary and repeat cesarean sections: agreement with clinical records.Am J Public Health. 1995; 85: 1143-1146
- To ‘C’ or not to ‘C’? Caesarean delivery upon maternal request: a review of facts, figures and guidelines.J Perinat Med. 2013; 41: 5-15
- Rise in “no indicated risk” primary caesareans in the United States, 1991-2001: cross sectional analysis.BMJ. 2005; 330: 71-72
- Cesarean delivery on maternal request in China: what are the risks and benefits?.Am J Obstet Gynecol. 2015; 212: 817.e1-817.e9
- Recent trends in vaginal birth after cesarean delivery: United States, 2016-2018.NCHS Data Brief. 2020; : 1-8
- The accuracy of predicting parity as a prerequisite for cesarean delivery on maternal request.Obstet Gynecol. 2008; 112: 285-289
- The ethics of access: who is offered a cesarean delivery, and why?.Hastings Cent Rep. 2015; 45: 15-19
- Macrosomia: ACOG Practice Bulletin, Number 216.Obstet Gynecol. 2020; 135: e18-e35
Article Info
Publication History
Published online: October 07, 2021
Accepted:
October 4,
2021
Received in revised form:
September 24,
2021
Received:
June 29,
2021
Footnotes
The authors report no conflict of interest.
No funding was received for this study.
Cite this article as: Trahan MJ, Czuzoj-Shulman N, Abenhaim HA. Cesarean delivery on maternal request in the United States from 1999 to 2015. Am J Obstet Gynecol 2022;226:411.e1-8.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
