ABSTRACT
There is insufficient evidence (lack of any trial) to assess the benefits and risks of a policy of CDMR (only indication: woman’s desire; also called elective CD) compared with trial of labor in term women with singleton gestations in cephalic presentation. The most common reason for a request for CDMR is fear of labor pain. CDMR should not be motivated by the unavailability of effective pain medication. There is also no randomized controlled trial (RCT) to evaluate the obstetrician recommendation for CD not based on an accepted indication. As there are no such trials, there is insufficient evidence to assess the long-term maternal and neonatal morbidity and mortality of CD or labor. There is insufficient evidence on the impact of counseling during pregnancy with the aim of reducing the incidence of CDMR (3). The incidence of women (without prior CD) preferring CDMR in a systematic review of studies is about 10%, and even less in developed countries (4). A practitioner is not obligated to perform a CDMR but should appropriately refer the woman as necessary.
