Al-Mufti R, McCarthy A, Fisk NM Survey of obstetricians' personal preference and discretionary practice. Eur J Obstet Gynaecol Reprod Biol. 1997; 73:(1)1-4

Amu O, Rajendran S Should doctors perform an elective caesarean section on request. Maternal choice alone should not determine method of delivery. BMJ. 1998; 317:(7156)463-5

Bick D Media portrayal of birth and the consequences of misinformation. Midwifery. 2010; 26:(2)147-8

Bost BW Cesarean delivery on demand: what will it cost?. Am J Obstet Gynecol. 2003; 188:(6)1418-23

Bragg F, Cromwell DA, Edozien LC, Gurol-Urganci I, Mahmood TA, Templeton A, van der Meulen JH Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. BMJ. 2010; 341

Normal birth and its meaning: a discussion paper. 2013. (accessed 29 July 2015)

London: HMSO; 2004

London: HMSO; 2007

London: HSMO; 2013

Druzin ML, El-Sayed YY Caesarean delivery on maternal request: wise use of finite resources? A view from the trenches. Semin Perinatol. 2006; 30:(5)305-8

Elmir R, Schmied V, Wilkes L, Jackson D Women's perceptions and experiences of a traumatic birth: a meta-ethnography. J Adv Nurs. 2010; 66:(10)2142-53

Feldman GB, Freiman JA Prophylactic caesarean at term?. N Engl J Med. 1985; 312:(19)1264-7

Fenwick J, Staff L, Gamble J, Creedy DK, Bayes S Why do women request caesarean section in a normal, healthy first pregnancy?. Midwifery. 2010; 26:(4)394-400

Furedi F Celebrity culture. Soc. 2010; 47:493-7

Habiba M, Kaminski M, Da Frè M, Marsal K, Bleker O, Librero J, Grandjean H, Gratia P, Guaschino S, Heyl W, Taylor D, Cuttini M Caesarean section on request: a comparison of obstetricians' attitudes in eight European countries. BJOG. 2006; 113:(6)647-56

Health and Social Care Information Centre. NHS Maternity Statistics — England 2012–13. 2013. (accessed 17 August 2015)

Hofberg K, Ward MR Fear of pregnancy and childbirth. Postgrad Med J. 2003; 79:(935)505-10

Hollins Martin CJ How can we improve choice provision for childbearing women?. British Journal of Midwifery. 2007; 15:(8)480-4

Jomeen J Choice in childbirth: a realistic expectation?. British Journal of Midwifery. 2007; 15:(8)485-90

Jomeen J The paradox of choice in maternity care. J Neonat Nurs. 2012; 18:(2)60-2

Jordan B Authoritative knowledge and its construction. In: Davis-Floyd RE, Sargent CF California: University of California Press; 1997

Kitzinger SOxon: Routledge; 2006

Lavender T, Kingdon C, Hart A, Gyte G, Gabbay M, Neilson JP Could a randomised controlled trial answer the controversy relating to elective caesarean section? National survery of consultant obstetricians and heads of midwifery. BMJ. 2005; 331:(7515)490-1

Lavender T, Hofmey GJ, Neilson JP Caesarean section for non-medical reasons at term. Cochrane Database Syst Rev. 2012; 3

Layne LNew York: Routledge; 2003

Lewis G, Clutton-Brock T, Cooper G Why Mothers Die 2000–2002: The Sixth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.London: RCOG; 2004

Lovine VNew York: Pocket Books; 1995

Ludwig H, Loeffer FE Caesarean section on demand – an ethical dilemma. Arch Gynecol Obstet. 2001; 264:(4)169-70

Marx H, Wiener J, Davies N A survey of the influence of patient's choice on the increase in the caesarean section rate. J Obs Gynae. 2001; 21:(2)124-7

McCourt C, Weaver J, Statham H, Beake S, Gamble J, Creedy DK Elective caesarean section and decision making: a critical review of the literature. Birth. 2007; 34:(1)65-79

McFarlin BL Elective caesarean birth: issues and ethics of an informed decision. J Midwifery Womens Health. 2004; 49:(5)421-9

Namey EE, Lyerly AD The meaning of ‘control’ for childbearing women in the US. Soc Sci Med. 2010; 71:(4)769-76

Guidelines on Caesarean Section GG132 2011.London: NICE; 2011

Parliamentary Office of Science and Technology. Caesarean sections. 2002. (accessed 4 August 2015)

Domiciliary midwifery and maternity bed needs (Peel Report).London: HMSO; 1970

Regan M, McElroy K Women's perceptions of childbirth risk and place of birth. J Clin Ethics. 2013; 24:(3)239-52

Robson S, Carey A, Mishra R, Dear K Elective caesarean delivery at maternal request: a preliminary study of motivations influencing women's decision-making. Aust N Z J Obstet Gynaecol. 2008; 48:(4)415-2

Normal childbirth: position statement no: 4.London: RCM; 2004

Royal College of Midwives. New c-section guideline. 2011. (accessed 4 August 2015)

Royal College of Midwives. Better births. 2013. (accessed 4 August 2015)

Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. National Sentinel Caesarean Section Audit Report 2001. 2001. (accessed 4 August 2015)

Royal College of Obstetricians and Gynaecologists. RCOG statement on NICE updated guidelines on caesarean section. 2011. (accessed 17 August 2015)

Visco AG, Viswanathan M, Lohr KN, Wechter ME, Gartlehner G, Wu JM, Palmieri R, Funk MJ, Lux L, Swinson T, Hartmann K Caesarean delivery on request maternal and neo-natal outcomes. Obstet Gynaecol. 2006; 108:(6)1517-29

Viswanathan M, Visco AG, Hartmann K, Wechter ME, Gartlehner G, Wu JM, Palmieri R, Funk MJ, Lux L, Swinson T, Lohr KN Caesarean delivery on maternal request. Evid Rep Technol Access (full rep). 2006; 133:1-138

Wagner M Midwifery in the industrialized world. J Soc Obstet Gynecol Canada. 1998; 20:1225-34

Wagner M ‘Choosing caesarean section’. Lancet. 2000; 356:1677-80

Walsh DJ Childbirth embodiment: problematic aspects of current understanding. Socio Health Illn. 2010; 32:(3)486-501

Caesarean section by maternal request

02 September 2015
Volume 23 · Issue 9


Caesarean section by maternal request (CSMR) is the provision of a caesarean section when requested by the mother, with no medical indication. This paper aims to provide a narrative overview of CSMR to inform clinicians about the pertinent issues. It will examine current provision of CSMR in the UK and contextualise it among prevailing social and societal factors. It will explore in detail the reasons why women may choose caesarean section, and provide arguments for and against the provision of CSMR on the NHS.

The emergence of caesarean section by maternal request (CSMR) as a concept is closely related to a shift in the perception of childbirth from a physiological process to a medical one, as has occurred since the early 20th century. Prevailing health-care philosophy over that period has focused on safety and the management of risk—a view that has consequently entered into the thinking of the public (Regan and McElroy, 2013). The outcome of a pathologised approach to childbirth is that it requires technological management in hospital (Clews, 2013). Influential historical publications have emphasised and reinforced the necessity for medical management of childbirth; the Peel report in 1970 recommended that all births should take place in hospital (Peel, 1970). In 1985, a study published in the New England Journal of Medicine advocated prophylactic caesarean section to avoid risk linked to anxiety around anticipation of delivery (Feldman and Freiman, 1985). Around that time, eminent obstetricians openly advocated caesarean sections instead of vaginal births. A 1997 study of female London obstetricians (Al-Mufti et al, 1997) found that 31% would prefer a caesarean section for themselves. Furthermore, a well-known book of the time stated: ‘With a scheduled caesarean section, you and your doctor have agreed to a time at which you will enter the hospital in a fairly calm and leisurely fashion, and he or she will extract your baby through a small slit at the top of your pubic hair. There are a lot of reasons to schedule a caesarean section…’ (Lovine, 1995: 217–8).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month