Peer Reviewed

Health Outcomes

Cesarean Delivery Is Linked to Improved Outcomes in Certain Pregnancies

Cesarean delivery on maternal request for low-risk pregnancies may result in better short-term outcomes than vaginal delivery, according to the results of a recent study. This finding comes despite widespread recommendations within the United States, Canada, and Europe of vaginal delivery over cesarean section.

“Given the financial and resource implications of cesarean deliveries on health care systems, the contribution of cesarean deliveries on maternal request (CDMR) to rising cesarean section rates is of ongoing interest,” the study authors wrote. “Women may prefer CDMR for many reasons, including scheduling convenience, anxiety regarding labor pain, perceptions that the quality of obstetrical care is better for women who have cesarean deliveries, and concerns about possible urinary incontinence and sexual dysfunction after vaginal delivery.”

A population-based retrospective cohort study was conducted in Ontario, Canada. Included were 422,210 women between April 2012 and March 2018.

The results indicated that the 0.4% of women who planned CDMR had a lower risk of adverse outcomes than the 99.6% of women who planned vaginal delivery (0.33-0.53, 85% CI). In addition, the Weighted Adverse Outcome Score was lower for the planned CDMR group (-2.02 – -0.55, 95% CI), but the Severity Index was the same between both groups (-7.4 – 14.5, 95% CI).

Late maternal age, higher education, conception via in vitro fertilization, anxiety, nulliparity, White race, delivery at a hospital providing higher levels of maternal care and obstetrician-based antenatal care were among the factors associated with planned CDMR.

“Planned CDMR is associated with a decreased risk of short-term adverse outcomes compared with planned vaginal delivery. Investigation into the long-term implications for CDMR is warranted,” the researchers concluded.


—Leigh Precopio



Guo Y, Murphy MSQ, Erwin E, et al. Birth outcomes following cesarean delivery on maternal request: a population-based cohort study. CMAJ. 2021;198(18):e634-3644. doi: /10.1503/cmaj.202262