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C-sections are now the most common in-patient surgical procedure performed in North America and elsewhere. The contribution of caesarean deliveries by maternal request in the absence of medical indications (CDMR) to rising C-section rates are largely unknown.
There is limited evidence on the short-term risks and benefits of CDMR and existing data are inconsistent. Importantly, analyses are frequently limited by inadequate case definitions and confounding baseline maternal and neonatal factors associated with the obstetrical outcomes analyzed. A 2012 Cochrane review on RCT evidence comparing outcomes between planned C-section birth in women with no indication for C-section versus planned vaginal birth revealed no such RCT. OMNI consultations with obstetrical colleagues unanimously reject the idea of a RCT for ethical issues, and mothers we engaged with were reticent to participate in a RCT of this nature. Thus, in the absence of conclusive clinical trial data, there is an urgent need for high quality data from observational studies.
In this pillar we apply an “intention-to-treat” approach to address notable methodological challenges associated with our research question. Our goal is to establish determinants of CDMR and assess the short-term maternal and neonatal outcomes of CDMR relative to planned vaginal delivery. We are further examining longer-term neonatal and child outcomes associated with CDMR, including breastfeeding outcomes, upper-respiratory tract infections, childhood asthma and neuro-developmental outcomes.
We are taking a two-pronged approach to addressing knowledge gaps related to the potential risks and benefits of CDMR. The two proposed studies have their own strengths and weaknesses and in parallel the studies can complement each other:
The results of this pillar will be applied to educational materials and professional guidelines to help expectant mothers and their health professionals make informed decisions.