Ethics and “Cesarean Delivery on Maternal Demand”

There is considerable ongoing debate about whether physicians should supply cesarean delivery to patients purely on the basis of maternal demand. This debate is marred by serious definitional problems. Although planned elective cesareans share a risk-profile with “cesarean delivery on maternal demand,” not every case of planned elective cesarean results from maternal demand. Ethical and practical considerations counsel using language that is more neutral on the question of the reason for, and process of decision-making leading to, cesarean delivery. Consideration of the risks and benefits of planned elective cesarean, coupled with the desirability of a prophylactic rule limiting physicians' offers of elective cesareans, counsels against making routine offers of elective cesareans to patients. When patients themselves have initiated the conversation about the procedure, physicians may supply elective cesareans only after serious and objective discussion about its risks and benefits.