Elective Cesarean Section for Maternal Preference

N Engl J Med . 2026;394;603–605. doi:10.1056/NEJMclde2504787 A clinical scenario presents a 33-year-old woman at 36 weeks’ gestation with her first pregnancy who requests a planned cesarean delivery (CD) for personal reasons. Her pregnancy has been uncomplicated, with normal vital signs, reassuring laboratory results, and normal ultrasound findings. She expresses fear of complications during vaginal birth (VB), specifically citing her sister’s experience with shoulder dystocia that resulted in permanent Erb’s palsy. In addition, she values the predictability of scheduling delivery in advance because of professional obligations. The clinician must decide whether to honor her request for an elective CD or to recommend a planned VB unless a medical indication for surgery arises.