Elective Cesarean Section- the Right Choice for Whom?

Cesarean section rates continue to rise. Reasons include changing demographics, altered clinical practice, and an increasing awareness of traumatic childbirth amongst the public, resulting in the phenomenon of 'Cesarean Section on demand'. Obstetricians are involved in an increasingly acrimonious discussion, without having access to data that would allow true 'informed consent' regarding the choice of delivery mode. There are no scientific grounds for identifying an 'appropriate' level for Cesarean section rates, and no data to help us in counselling women who ask for elective Cesarean delivery. A 'Term Cephalic Trial' may provide such information, but poses major logistic and ethical challenges. The key to a successful resolution of this issue may lie in individualized risk assessment. This has now become possible. Maternal age, a history of Cesarean Section in the parturient's mother, maternal body mass index, cervical length and/ or Bishop score, pelvic organ mobility and engagement of the fetal head are some of the factors that have recently been shown to be associated with delivery mode in nulliparous women. Individual risk assessment may soon allow us to construct intervention trials that will be ethically sound, logistically feasible and resource- neutral. Even more importantly, we may eventually be able to provide true 'informed consent' to women considering elective Cesarean delivery.