Caesarean Delivery by mother's choice is becoming popular and has contributed to the rising incidence of caesarean sections worldwide

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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

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CAESAREAN BY CHOICE(CDMR)
 Caesarean delivery on maternal
request
 Caesarean section birth, requested by
the pregnant woman without a
medical reason

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CDMR
Maternal request becoming
increasingly common
Earlier not well recognized

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CDMR
 There are Controversies
 Focus of attention both for clinical &
ethical reasons
Cesarean section on demand
is unethical--- FIGO 1999

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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

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 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

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Prevalence of CDMR
1 to 18 percent of all Caesarean
deliveries worldwide,
1 to 3 percent of all Caesarean
deliveries in the US

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 WHO – 10 TO 15%
 UK – 25%
 US – 33%
 BRAZIL - > 50%
Worldwide Incidence

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Difference- Elective CS & CDMR
An elective caesarean section done on
the basis of some medical conditions
CDMR - mother's preference for the
delivery mode

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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

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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

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Increasing Incidence………..
Safer anesthesia practices
Fear of labour pain
Improved techniques

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Survey of Doctors
Obstetricians, Urogynecologists &
Colorectal surgeons
Preference for cesarean by request for
themselves and their family members

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Potential Benefits of CDMR
Planned
timing of birth

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Initiation of Breastfeeding – Late
More chances of neonatal respiratory
complications
 Anaesthesia
Surgery related
Disadvantages of CDMR

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Risk Ratio
Emergency Caesarean– 16 %
Instrumental Vaginal Delivery - 13 %
Elective Caesarean- 7 %

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Min gestation should be 39 weeks or more
Or till lungs are mature
When to undergo
CDMR?

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LABOR AND DELIVERY:
IT’S NOT ALWAYS WHAT
YOU EXPECTED

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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

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More Research is needed in future……

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To promote safe, effective and
satisfying
maternity care for all women
and their families through
research, education , expertise
and advocacy
Mission

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We individualize every patient
We follow ethical principles
Efficient, highly skilled team of doctors,
technicians & paramedical staff
Manage high risk cases
Our USP

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Your needs: Our priority
Excellent teamwork
Well equipped infrastructure with quality care
Patient friendly environment
Blood Bank facility
Neonatal ICU facility
Our USP