When is a maternal request caesarean section not a maternal request?

When a caesarean section is performed on a singleton pregnancy when there is no clinical indication, this is deemed a maternal request caesarean section (CSMR). The procedure contributes to the ever rising rates of caesarean sections in the UK, as well as the rates associated risks and subsequent financial burden to the NHS. The ethics of exposing these otherwise healthy women to the risks of surgery and the increasing financial strain on our healthcare system becomes complicated with the importance of assessing and managing the patients’ psychological well-being and the demand to promote patient choice and autonomy. This article considers the main reasons behind why we encounter CSMRs, while exploring the ethical dilemmas we as obstetricians face. We will also look at ways to manage these women, with suggestions of support and evidence to provide in order for them to make an informed decision.