Primary and repeat cesarean delivery rates have reached their highest levels both nationally and internationally, with 30.3% of live births in the United States being cesarean deliveries. Some cite the increase in cesarean delivery on maternal request (CDMR) as a contributing factor, although data have yet to confirm this. Concern about the rising number of cesareans performed, and the lack of clear knowledge about health outcomes for both mother and neonate as a result of this trend prompted the National Institute of Child Health and Human Development and the Office of Medical Applications of Research of the National Institutes of Health to convene a State-of-the-Science Conference on the topic of CDMR from March 27 to 29, 2006. Before this conference, a study was conducted by the American College of Obstetricians and Gynecologists to assess practice patterns and opinions related to CDMR among obstetrician-gynecologists. It was found that most obstetrician-gynecologists recognized an increased demand for CDMR in their practices. Conclusions from this study and the conference are reviewed along with more recent research on this topic.