Objective: To explore the attitudes of obstetricians to performe a caesarean section on maternal request in the absence of medical indication. Design: Cluster sampling cross-sectional survey. Setting: Neonatal Intensive Care Unit (NICU) associated maternity units in eight European countries. Population: Obstetricians with at least 6 months clinical experience. Methods: NICU-associated maternity units were chosen by census in Luxembourg, Netherlands and Sweden and by geographically stratified random sampling in France, Germany, Italy, Spain and UK. An anonymous, self-administered questionnaire was used for data collection. Main outcome measures: Obstetricians' willingness to perform a caesarean section on maternal request. Results: One hundred and five units and 1530 obstetricians participated in the study (response rates of 70 and 77%, respectively). Compliance with a hypothetical woman's request for elective caesarean section simply because it was 'her choice' was lowest in Spain (15%), France (19%) and Netherlands (22%); highest in Germany (75%) and UK (79%) and intermediate in the remaining countries. Using weighted multivariate logistic regression, country of practice (P <0.001), fear of litigation (P = 0.004) and working in a university-affiliated hospital (P = 0.001) were associated with physicians' likelihood to agree to patient's request. The subset of female doctors with children was less likely to agree (OR 0.29, 95% CI 0.20-0.42). Conclusions: The differences in obstetricians' attitudes are not founded on concrete medical evidence. Cultural factors, legal liability and variables linked to the specific perinatal care organisation of the various countries play a role. Greater emphasis should be placed on understanding the motivation, values and fears underlying a woman's request for elective caesarean delivery.
|Number of pages||10|
|Journal||BJOG: An International Journal of Obstetrics and Gynaecology|
|Publication status||Published - Jun 2006|
- Maternal request
- Obstetricians' attitude
ASJC Scopus subject areas
- Obstetrics and Gynaecology