In 2007, the American College of Obstetricians and Gynecologists published an important and interesting study asking practicing obstetricians about their knowledge, beliefs, and practices regarding the risks and benefits of elective (not medically indicated) and non-elective cesarean delivery, as well as their counseling practices and department policies regarding elective cesarean.

About half of the obstetricians responding said they believed that women had the right to cesarean on request, and the same number stated that they had performed at least one such delivery.  They attribute the increase in requests from women to the increase of information from the media and to convenience.  Interestingly, women obstetricians were more negative toward cesarean delivery on maternal request than men and mentioned more risks and fewer benefits.    I would be interested in hearing from women themselves about why you might consider an elective cesarean, where you got information about this, and what you consider the risks and the benefits to be.  Also, if anyone has a story about how they were counseled regarding the risks of elective cesarean, that would be interesting to hear as well!

IMG_2003
Nancy at a Cesarean birth in Baglung, Nepal – definitely not elective!

Obstetrics & Gynecology 2007;109:57-66
2007 by The American College of Obstetricians and Gynecologists

Cesarean Delivery on Maternal Request Obstetrician Gynecologists’ Knowledge, Perception, and Practice Patterns

Barbara A. Bettes, PhD1, Victoria H. Coleman, MA2, Stanley Zinberg, MD, MS3, Catherine Y. Spong, MD4, Barry Portnoy, PhD5, Emily DeVoto, PhD6 and Jay Schulkin, PhD1

OBJECTIVE: To examine obstetrician / gynecologists’ knowledge, opinions, and practice patterns related to cesarean delivery on maternal request.

METHODS: Questionnaires were mailed to 1,031 American College of Obstetricians and Gynecologists Fellows in February 2006, with a response rate of 68%. The questionnaire queried respondents’ demographic characteristics, practices and attitudes surrounding vaginal and cesarean deliveries, knowledge and beliefs regarding the risks and benefits of elective and nonelective cesarean delivery, and counseling practices and department policies for cesarean delivery on maternal request.

RESULTS: About half of respondents believe women have the right to cesarean delivery on maternal request, and a similar percentage acknowledge having performed at least one cesarean delivery on maternal request. Fifty-eight percent of respondents note an increase in patient inquiries regarding cesarean delivery over the past year, yet most of their practices do not have a policy regarding this procedure. Respondents attribute the increase in inquiries to the increase of information from the media and to convenience. Respondents cited more risks than benefits of cesarean delivery on maternal request, and nearly all discuss these risks with patients who are considering one. Females were more negative toward cesarean delivery on maternal request than males and endorsed more risks and fewer benefits. There were no relationships between assessment of risks and benefits or practice with clinician age or patient characteristics.

CONCLUSION: Most obstetrician / gynecologists in this study recognized an increased demand for cesarean delivery on maternal request within their practices, while believing that the risks of this procedure outweigh the benefits. Clinicians would benefit from strong evidence regarding risks and benefits, evidence that is crucial to guiding policy making with regard to cesarean delivery on maternal request.

LEVEL OF EVIDENCE: III

Copyright 2007 by the American College of Obstetricians and Gynecologists.