Childbirth with Caesarean section on the pregnant woman´s request - advantages and disadvantages for the mother and child

Background

The frequency of ceasarean section increased during the 1970’s (5 percent of the deliveries 1973), decreased somewhat during the 1980’s, increased significantly during the period 1993-2006 (18 percent 2006), and has since then stayed at a steady level at 18 percent nationally with considerable variation between hospitals and regions in Sweden (National Board of Health and Welfare, SoS article number 2019-12-6529).

Planned ceasarean section (with or without medical indication) has during the latest twenty-year period stayed at the level of 6-8 percent and the acute ceasarean sections a few percent higher.

Some of the pregnant women request a ceasarean section instead of a vaginal delivery.

Primiparous women may of fear of giving birth vaginally or of other reasons request a planned ceasarean section. Fear of vaginal birth may be based on the risk for rupture, pain, uterine prolapse, urine or fecal incontinence or that the sexual life will be affected negatively.

Fear of harm to the baby during a vaginal birth is also expressed. Sometimes no specific reason is expressed.

The frequency of ceasarean section on the pregnant women’s request is low in Sweden among primiparous women (SoS article number 2019-12-6529).
Only five percent of the primiparous women were delivered by planned ceasarean section, and of them only every fourth was made on the mother’s request.

Among multiparous women 9,4 percent were delivered with planned ceasarean section, and around a third of them were made on the mother’s request.

The largest group who request a ceasarean section are multiparous women who has undergone a previous ceasarean section or an earlier complicated delivery (1,2).

The proportion ceasarean sections based on psychosocial indications increased during the period 1990-2001 with as much as 80 percent (SoS article number 2019-12-6529).

On the basis of the very extensive information published by the National Board of Health and Welfare of the short term medical complications for the mother after planned ceasarean section and vaginal delivery (SoS article number 2018-5-20 och 2019-12-6529) a complementary literature search and assessment will only be made on the mother’s long term complications.
In addition, the knowledge will be complemented with the child’s short- and long-term complications and a qualitative analysis will be made of experiences of the process of the ceasarean section delivery on the mother’s request.
Health economic consequences and an ethical discussion is also included in the assessment.

Aim

 

Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) has received a government assignment to assess the scientific support for ceasarean section on the mother’s request.

The assessment will include a systematic review regarding positive and negative effects.

Experiences will be analyzed through weighing together studies with qualitative methodology. Health economic aspects are analyzed on the basis on the systematic review. Ethical aspects will be highlighted and discussed.

Ongoing Projects

Planned to be published: Quarter 4, 2021
Contact SBU: registrator@sbu.se
Registration no: SBU 2020/109