OBJECTIVE: To explore the attitudes of obstetricians to perform 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 1,530 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.
OBJECTIVE: To explore the attitudes of obstetricians to perform 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 1,530 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.
Authors: Jun Zhang; James Troendle; Uma M Reddy; S Katherine Laughon; D Ware Branch; Ronald Burkman; Helain J Landy; Judith U Hibbard; Shoshana Haberman; Mildred M Ramirez; Jennifer L Bailit; Matthew K Hoffman; Kimberly D Gregory; Victor H Gonzalez-Quintero; Michelle Kominiarek; Lee A Learman; Christos G Hatjis; Paul van Veldhuisen Journal: Am J Obstet Gynecol Date: 2010-08-12 Impact factor: 8.661
Authors: J C Rivo; M Amyx; V Pingray; R A Casale; A E Fiorillo; H B Krupitzki; J D Malamud; M Mendilaharzu; M L Medina; A B Del Pino; L Ribola; J A Schvartzman; G M Tartalo; M Trasmonte; S Varela; F Althabe; J M Belizán Journal: BJOG Date: 2018-02-22 Impact factor: 6.531
Authors: Yanfang Guo; Malia S Q Murphy; Erica Erwin; Romina Fakhraei; Daniel J Corsi; Ruth Rennicks White; Alysha L J Harvey; Laura M Gaudet; Mark C Walker; Shi Wu Wen; Darine El-Chaâr Journal: CMAJ Date: 2021-05-03 Impact factor: 8.262
Authors: Gianpaolo Maso; Salvatore Alberico; Lorenzo Monasta; Luca Ronfani; Marcella Montico; Caterina Businelli; Valentina Soini; Monica Piccoli; Carmine Gigli; Daniele Domini; Claudio Fiscella; Sara Casarsa; Carlo Zompicchiatti; Michela De Agostinis; Attilio D'Atri; Raffaela Mugittu; Santo La Valle; Cristina Di Leonardo; Valter Adamo; Silvia Smiroldo; Giovanni Del Frate; Monica Olivuzzi; Silvio Giove; Maria Parente; Daniele Bassini; Simona Melazzini; Secondo Guaschino; Francesco De Seta; Sergio Demarini; Laura Travan; Diego Marchesoni; Alberto Rossi; Giorgio Simon; Sandro Zicari; Giorgio Tamburlini Journal: PLoS One Date: 2013-06-05 Impact factor: 3.240