**5. Conclusion**

The following chapter has comprehensively summarized the current clinical scenario of caesarean section on maternal request and highlighted some key points through a vigorous review of the literature. CS can be a promising surgical intervention in medically relevant cases but should be guided by ethically driven norms. Since data unavailability or lack of information on birth certificates/discharge sheets accounts for a major limitation in addressing the actual prevalence of CSMR, appropriate registries should be designed for reporting and recording patients seeking elective CS. Strategic measures should be implemented to identify and manage the determinants of CSMR (medical, psychological and psychosocial, social, cultural and economic) that may lead women to request CS delivery and thus contribute to the massive global economic impact.

Although CSMR has been linked to certain beneficial outcomes (e.g. reduced urinary incontinence and pelvic organ prolapse, reduced rate of PTSD and depression, and lesser intrapartum complications), it still imposes maternal (e.g. post-partum haemorrhage and infection, visceral damage, placenta accrete, placental abruption and complications in future pregnancy) and foetal (stillbirth, asphyxia, respiratory distress and other pulmonary infections) adverse outcomes as well. Since CS is associated with both short- and long-term health complications, it is essential to control the potential risk factors before proceeding with a planned C-section.

CS requests from the mother should be approved by informed consent, which pinpoints the complications, amplifies the absence of a clinical indication and provides necessary information about this absence. In conclusion, medical professionals should seek to provide women with the right advice, not to discourage them from having a caesarean delivery but, more importantly, to support them in having a positive birth experience. Future approaches and efforts should be directed toward mitigating clinically unrequired CS procedures due to medical malpractices, lack of awareness in women and the underlying determinants of elective CS that led to its widespread practices.
