Cesa­rean Deli­ve­ry on Mater­nal Request
(Res­source pour l’ate­lier 12)

NIH State-of-the-Science Confe­rence : Cesa­rean Deli­ve­ry on Mater­nal Request
March 27 – 29, 2006
Natio­nal Ins­ti­tutes of Health, Bethes­da, Maryland
Pre­sen­ta­tion (PDF)
Final sta­te­ment (PDF)

Des­pite the natio­nal goal of redu­cing rates of cesa­rean deli­ve­ry to 15 percent of births esta­bli­shed as part of Heal­thy People 2010, cesa­rean deli­ve­ry rates have conti­nued to increase. In 2004, 1.2 mil­lion or 29.1 percent of births in the Uni­ted States were by cesa­rean deli­ve­ry. An esti­ma­ted 2.5 percent of births that year were cesa­rean deli­ve­ries per­for­med on request, in the absence of medi­cal neces­si­ty, and the rate of cesa­reans on request appears to be gro­wing rapid­ly over time.

The poten­tial bene­fits of elec­tive cesa­rean deli­ve­ry as com­pa­red to vagi­nal deli­ve­ry are not ful­ly unders­tood but are thought to include decrea­sed risk of uri­na­ry incon­ti­nence, pel­vic organ pro­lapse, anal sphinc­ter damage, and fecal incon­ti­nence. Elec­tive cesa­rean deli­ve­ry also has the bene­fit of flexible timing for mother and phy­si­cian. Howe­ver, like any major sur­gi­cal pro­ce­dure, there are risks asso­cia­ted with cesa­rean deli­ve­ry. Risks that are known to be higher for cesa­rean deli­ve­ries than for vagi­nal deli­ve­ry include adverse reac­tions to anes­the­sia, brea­thing pro­blems, blee­ding, infec­tion, uri­na­ry tract inju­ry, and inju­ry to the baby. In addi­tion, reco­ve­ry time fol­lo­wing cesa­rean deli­ve­ry is typi­cal­ly lon­ger than for vagi­nal delivery.

Given these risks, any deci­sion to deli­ver by cesa­rean deli­ve­ry when vagi­nal deli­ve­ry is also avai­lable should be infor­med by the best pos­sible infor­ma­tion regar­ding poten­tial health out­comes, good and bad, for both mother and baby. Toward that end, the Natio­nal Ins­ti­tute of Child Health and Human Deve­lop­ment and the Office of Medi­cal Appli­ca­tions of Research of the Natio­nal Ins­ti­tutes of Health will convene a State-of-the-Science Confe­rence from March 27 to 29, 2006, to assess the avai­lable scien­ti­fic evi­dence rele­vant to the fol­lo­wing questions :

• What is the trend and inci­dence of cesa­rean deli­ve­ry over time in the Uni­ted States and other coun­tries (when pos­sible sepa­rate by intent)?
• What are the short-term (under one year) and long-term bene­fits and harms to mother and baby asso­cia­ted with cesa­rean by request ver­sus attemp­ted vagi­nal delivery ?
• What fac­tors influence bene­fits and harms ?
• What future research direc­tions need to be consi­de­red to get evi­dence for making appro­priate deci­sions regar­ding cesa­rean on request or attemp­ted vagi­nal delivery ?

An impar­tial, inde­pendent panel is char­ged with revie­wing the avai­lable publi­shed lite­ra­ture in advance of the confe­rence, inclu­ding a sys­te­ma­tic lite­ra­ture review com­mis­sio­ned through the Agen­cy for Heal­th­care Research and Qua­li­ty. The first day and a half of the confe­rence consists of pre­sen­ta­tions by expert resear­chers and prac­ti­tio­ners, and open public dis­cus­sions. On Wed­nes­day, March 29, the panel will present a sta­te­ment of its col­lec­tive assess­ment of the evi­dence to ans­wer each of the ques­tions above. The panel will also hold a press confe­rence to address ques­tions from the media. The draft sta­te­ment will be publi­shed online later that day, and the final ver­sion will be relea­sed approxi­ma­te­ly 6 weeks later.

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