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Rising Cesarean Delivery Rates: The Impact of Cesarean Delivery on Maternal Request.

Coleman, Victoria H. PhD*; Lawrence, Hal MD†; Schulkin, Jay PhD‡

Obstetrical & Gynecological Survey: February 2009 - Volume 64 - Issue 2 - pp 115-119
doi: 10.1097/OGX.0b013e3181932dda
CME Program: CATEGORY 1 CME REVIEW ARTICLES 4, 5, AND 6: CME REVIEW ARTICLE 4

Primary and repeat cesarean delivery rates have reached their highest levels both nationally and internationally, with 30.3% of live births in the United States being cesarean deliveries. Some cite the increase in cesarean delivery on maternal request (CDMR) as a contributing factor, although data have yet to confirm this. Concern about the rising number of cesareans performed, and the lack of clear knowledge about health outcomes for both mother and neonate as a result of this trend prompted the National Institute of Child Health and Human Development and the Office of Medical Applications of Research of the National Institutes of Health to convene a State-of-the-Science Conference on the topic of CDMR from March 27 to 29, 2006. Before this conference, a study was conducted by the American College of Obstetricians and Gynecologists to assess practice patterns and opinions related to CDMR among obstetrician-gynecologists. It was found that most obstetrician-gynecologists recognized an increased demand for CDMR in their practices. Conclusions from this study and the conference are reviewed along with more recent research on this topic.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Leaning Objectives: After reading this article, the reader should be able to outline risks and benefits associated with cesarean section, modify counseling for patients regarding cesarean delivery on maternal request to appropriately reflect known risks and benefits, and appraise ones personal practice with respect to cesarean delivery on maternal request.

*Research Consultant, ‡Director of Research, Research Department, and †Vice President of Practice Acivities, Practice Activities Division, The American College of Obstetricians and Gynecologists, Washington, DC

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2009. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Supported by grant 00105 from the Maternal and Child Health Bureau, Bethesda, MD.

All authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott Continuing Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprints requests to: Victoria H. Coleman, PhD, Department of Research, The American College of Obstetricians and Gynecologists, 409 12th St, SW, Washington, DC 20024. E-mail: vhcoleman@gmail.com.

© 2009 Lippincott Williams & Wilkins, Inc.