More and more mothers facing childbirth are asking for a cesarean. There are many reasons for this, ranging from the social and cultural to the personal, such as fear about the birth. A review article in the current issue of Deutsches Ärzteblatt International (Dtsch Arztbl 112: 489-95) by two Munich gynecologists, Ioannis Mylonas and Klaus Friese, considers the risks and benefits of cesarean delivery on maternal request.
Delivery by cesarean section is much more popular than it used to be. In 1991 a little over one delivery in six was by cesarean; now it is almost one in three. But, as the authors point out, a cesarean section remains a surgical procedure, with the risks of various harms, such as infection, injury to bladder or intestines, and risks related to anesthesia. Compared to a vaginal delivery, however, pain after the birth and vaginal injuries are rarer after a cesarean. The authors recommend that cesarean sections on request should be avoided, and vaginal delivery be abandoned only when there are medical reasons for doing so.