Maternal request cesarean section: How often does this occur?

Background: The cesarean section (CS) rate has increased rapidly in recent years in the US. This increase has been attributed in part to increasing numbers of women requesting CS in order to be able to avoid labor, choose a convenient date for delivery, or for other reasons. However, little research has measured how often women specifically request CS, either prior to or during labor. Methods: More than 3,000 women age 18 to 35 who were expecting their first child in Pennsylvania in 2009 to early 2011 were interviewed after 34 weeks gestation and one month after delivery to measure mode of delivery preferences and requests. Results: In the pre-delivery interview 94.0% indicated that they would prefer to deliver vaginally, 3.0% preferred CS and 3.0% had no preference. Overall, 70.6% delivered vaginally, 5.1% had planned CS (scheduled to occur prior to onset of labor) and 24.3% had unplanned CS. Only one study participant reported requesting a planned CS, and 3.7% reported requesting CS during labor. Among those who preferred vaginal delivery 28.0% delivered by CS, among those with no preference 44.4% did, and among those who preferred CS 59.2% did. The participant who requested a planned CS did have one, and among the women who requested CS during labor 45.3% did. Conclusions: Although explicit maternal request of planned CS prior to first delivery appears to be rare, women's preferences and requests as to mode of delivery do appear to influence whether they deliver by CS.