Elective primary cesarean delivery.

In 1985, the Journal published an article advocating elective cesarean delivery. 1 Although it was provocative, the article had little effect on obstetrical standards. At that time, most efforts within the discipline were focused on arresting the escalation of the rate of cesarean deliveries, 2 which had increased sharply during the preceding decade. Thus, despite that article, the rate of cesarean deliveries peaked a few years after the article appeared and then declined slightly. Two decades later, the discussion of elective cesarean delivery has been revitalized. The benefit– risk calculus associated with surgery has evolved, as techniques for surgery, anesthesia, infection control, and blood banking have improved and as new data have been published highlighting the potential risks associated with labor and vaginal delivery. Women live longer and have fewer children, making quality-of-life issues such as the long-term risk of incontinence associated with vaginal delivery more prominent and the risks associated with having multiple subsequent repeated procedures less prominent. Maternal autonomy as a central tenet of obstetrical decision making has been reinforced in both law and ethics. 3