[1] The concept of "Caesarean delivery on maternal request" (CDMR) is not well-recognized in health care, and consequently, when it occurs there are no mechanisms in place for reporting it for research or distinguishing it in medical billing.
an elective caesarean section was done on the basis of medical grounds; however, the existence of CDMR makes the mother's preference the determining factor for the delivery mode.
[1] The global nature of the CDMR phenomenon was underlined by a study that showed that in southeast China about 20% of women chose this mode of delivery.
Hospitals should institute strict monitoring of births to comply with full term (more than 39 weeks gestation) elective C-section guidelines.
Italian gynaecologist Enrico Zupi, whose clinic in Rome, Mater Dei, was under media attention for carrying a record of Caesarian sections (90% over total birth), explained: "We shouldn't be blamed.
[12] In contrast, a 2004 study in the British Medical Journal retrospectively analysed a large number of Caesarean sections in England and stratified them by social class.
[13] Some have suggested, due to the comparative risks of Caesarean section with an uncomplicated vaginal delivery, women should be discouraged or forbidden from choosing it.
[1] The available evidence suggests certain differences as follows: Proponents for CDMR point out that it facilitates the birth process by performing it at a scheduled time under controlled circumstances, with typically less bleeding, and less risk of trauma to the baby.
[1] Subsequent to the NIH report a large review from the USA of almost 6 million births was published that suggested that neonatal mortality is 184% higher in babies born by cesarean section.
[19][20][21] In response to this criticism, the authors published a second paper analyzing the same cohort, in which they did not systematically exclude vaginal deliveries in which unexpected complications arose, and concluded that the increased risk of neonatal mortality associated with cesarean section was 69%, rather than 184%.
However, they did not address the inadequacies of their data set, and did not attempt to determine the degree of error introduced when identifying elective cesarean sections by birth certificate.