Caesarean section by maternal request
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).
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