Cesarean delivery on maternal request: the essential role of professional obligations
By Frank A. Chervenak in AJOG
DOI: 10.1016/j.ajog.2025.02.039
First author: Frank A. Chervenak
Journal: American Journal of Obstetrics & Gynecology
Month, year: January 2026
Synopsis
This expert review examines cesarean delivery on maternal request through the lens of professional responsibility in obstetrics. The authors define CDMR clearly and distinguish it from outdated and ambiguous terminology, emphasizing that it involves surgery without maternal or fetal medical indications. They synthesize ethical theory, clinical evidence, and international guidance to analyze how autonomy-based obligations intersect with beneficence-based professional duties. The review highlights that evidence comparing planned CDMR with planned vaginal delivery remains limited and often indirect, requiring caution in interpretation. Major professional organizations support CDMR only after thorough counseling, while continuing to recommend vaginal delivery as the preferred mode in the absence of indications. The authors propose a structured, trauma-informed informed consent framework that addresses cognitive bias, future reproductive risk, and health literacy.
