Caesarean delivery by Maternal Request (CDMR)

Caesarean Delivery by mother's choice is becoming popular and has contributed to the rising incidence of caesarean sections worldwide

1. Caesarean Section By Choice: A Primary Elective Caesarean Birth Dr Nupur Gupta Dr Monika Choudhary Dr Manjiri Deshpande Dept of Obstetrics & Gynecology Paras Hospital, Gurgaon

2. CAESAREAN BY CHOICE(CDMR) Caesarean delivery on maternal request Caesarean section birth, requested by the pregnant woman without a medical reason

3. CDMR Maternal request becoming increasingly common Earlier not well recognized

4. CDMR There are Controversies Focus of attention both for clinical & ethical reasons Cesarean section on demand is unethical--- FIGO 1999

5. It is ethically permissible to request for an elective Cesarean from an informed woman — but it is also acceptable to refuse if the surgeon feels it is not in the woman’s interest. ----ACOG 2003 CDMR

6. Vaginal birth remains the “preferred” approach and the safest option for most women and carries with it less risk of complications in pregnancy and subsequent pregnancies than Cesarean births… CDMR SOGC March 2004 promote natural childbirth through childbirth education

7. Prevalence of CDMR 1 to 18 percent of all Caesarean deliveries worldwide, 1 to 3 percent of all Caesarean deliveries in the US

8. WHO – 10 TO 15% UK – 25% US – 33% BRAZIL - > 50% Worldwide Incidence

9. Difference- Elective CS & CDMR A n elective caesarean section done on the basis of some medical conditions CDMR - mother's preference for the delivery mode

10. Reasons for CDMR Mother’s choice Woman's personal philosophy about childbirth Fear of vaginal delivery/PAIN Previous CS Previous traumatic vaginal delivery or childbirth experience Previous intrapartum death of fetus

11. Factors influencing CDMR rate Doctor’s age Total years of experience Involvement in private practice & research Unit’s annual delivery rate Number of obstetric beds Unit’s CS rate Whether the unit is referral Centre for high risk pregnancies or not

12. Increasing Incidence……….. Safer anesthesia practices Fear of labour pain Improved techniques

13. Survey of Doctors Obstetricians, Urogynecologists & Colorectal surgeons Preference for cesarean by request for themselves and their family members

14. Potential Benefits of CDMR Planned timing of birth Less chance of postdated pregnancy No fear of labour pain Less urinary & anal incontinence Less chances of Cerebral Palsy Less pelvic floor damage & prolapse Perinatal mortality, 10 times lower

15. Initiation of Breastfeeding – Late More chances of neonatal respiratory complications Anaesthesia Surgery related Disadvantages of CDMR

16. Risk Ratio Emergency Caesarean– 16 % Instrumental Vaginal Delivery - 13 % Elective Caesarean- 7 %

17. Min gestation should be 39 weeks or more Or till lungs are mature When to undergo CDMR?

18. LABOR AND DELIVERY: IT’S NOT ALWAYS WHAT YOU EXPECTED

19. Be prepared for anything! It’s wonderful to have a birth plan but be prepared for the possibility of an alternate route. Try not to get caught up in the disappointment and take in every moment.  I had a C-section, and I am no less of a mom than a woman who delivered naturally. That may not be the path I chose, but it is the path I was given. I have not only accepted it, but embraced it. I feel like it has even made me a stronger woman! Patient experiences……about Caesarean

20. More Research is needed in future……

21. To promote safe, effective and satisfying maternity care for all women and their families through research, education , expertise and advocacy Mission

22. We individualize every patient We follow ethical principles Efficient, highly skilled team of doctors, technicians & paramedical staff Manage high risk cases Our USP

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