CDMR

In comments to a recent post of mine Dream Mom opined that every pregnant woman wants two things: one, to have natural (vaginal) delivery, and two, to have her baby go home with her from the hospital. There was a time when I would have readily agreed with that, but lately I have to question how true the first wish is because there is a small, but perhaps growing, number of women choosing to deliver by caesarean section on maternal request (CDMR). This refers to caesarean delivery for a singleton pregnancy upon maternal request at term in the absence of any medical or obstetrical indications. In other words, a mother says, I don't want to go through labor, just give me a caesarean section.

When I first heard about CDMR, I thought this is crazy, do obstetricians really agree to this? Apparently some of them do, and they do it often enough that the National Institutes of Health saw fit to recently convene a group of experts to assess the state of current knowledge about CDMR. The result of that conference is a "State-of-the-science conference statement". In short, the experts said that there is really not enough evidence to recommend for or against CDMR.

Post partum hemorrhage, subsequent urinary incontinence, and surgical and traumatic complications might be less in women with CDMR versus women who have vaginal deliveries or unplanned caesarean sections. On the other hand, women with CDMR have longer stays in the hospital and might have more infections and more anesthetic complications, and breastfeed less. Babies born by CDMR have a higher chance of respiratory problems after birth, but might have less of a chance of birth injury and infection. Again, there is not enough data to adequately evaluate the good versus bad of CDMR.

My gut reaction to CDMR is that it can't be good to subvert Mother Nature's wishes regarding childbirth. As a person who believes in the value of scientific inquiry, though, I'm willing to wait for more information on the subject. I fear, though, that if CDMR becomes more accepted then some women will choose it based on fear of delivery, a fear that might be informed by less than reliable sources, such as baby showers and "horror" tales from "friends" about vaginal delivery. The amount of medical misinformation out there is amazing. I don't mean to trivialize the fear, though. Let's face it, the thought that a human being, even a small one, can emerge from an opening the size of the vagina is a bit daunting. But the pain of vaginal delivery can be dealt with, and all mothers should make their decisions based on real information, not scary stories.

I'm curious to see how this works out.