Cesarean Delivery on Maternal Request (CDMR); an ethical option?

A growing phenomenon in recent decades is “Cesarean Delivery on Maternal Request” (CDMR) — the delivery of a baby via a scheduled cesarean section, not for any medical reason, but because the mother desires not to have a vaginal delivery.

Is this an ethically legitimate medical practice? There are different arguments for or against. When one weighs the potential benefits and risks to both mother and baby, the scales don’t tip overwhelmingly towards one side or the other. Not unexpectedly, the principle of autonomy is one justification given in support of the practice: if a woman understands the benefits and the risks, so the argument goes, she should be free to make a decision in accordance with what she wants. (This begs the question of, should doctors be obligated to do an unindicated medical procedure simply because a patient requests it?) The principle of justice is often cited as a reason not to do CDMR; on this account, the increased expenses of surgery and prolonged hospital stays constitute an unjustified use of finite resources.

One of my concerns with CDMR is that it represents another example of our tendency to place faith in a technique or technology, to uncritically accept what is gained by the technique, the good that it promises (e.g., not having to undergo labor; control; the convenience of scheduling); without stopping to consider either the idea embedded in the technique, or what is lost by adopting the technique. One idea embedded in CDMR is that Pregnancy is a Medical Condition, a Disease that needs to be treated and cured. Now it is clear that there are some pregnancies that benefit from medical intervention. However, we extrapolate and make every delivery a techno-medical event, to the detriment of many, performed in hospitals and replete with fetal heart monitors and IVs and all the other indispensables of the modern delivery suite. (We are so inured to this idea of pregnancy-as-disease that most of us are surprised when we hear of a delivery taking place at home; some might even question the sanity of a decision to have a home delivery!) CDMR only reinforces this idea, moving us further away from understanding pregnancy and delivery for the “natural” and very human events that they are. As for what is lost by the practice of CDMR, there is an irreplaceable mother-child bonding time that occurs immediately post-partum. Sometimes, when a cesarean section is medically necessary or the mother or baby are ill, this precious time must necessarily be relinquished; but to forgo it for no necessity minimizes an ineffably important and human experience.

Is this an ethically legitimate practice? It’s perhaps not as clear as some other contested issues. But it seems to take us another step down a path — the medicalization and technicalization of all human experience — a path to a world brave and new, a path we will rue after we have gone too far down it to turn back. Ethically legitimate? Barely, maybe. Wise? I don’t think so.

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