Psychosocial indications for cesarean section. A retrospective study of 43 cases.

At Helsingborg Maternity Clinic the rate of elective cesarean section on psychosocial indications has increased. The purpose of this study was to identify and characterize those women requiring cesarean section despite the absence of obstetrical complications of pregnancy and childbirth and their reasons for doing so. Hospital case records from 1983 to 1987 were examined retrospectively. Nine women (20%) were primiparae, who for different reasons refused vaginal delivery; 34 (80%) were multiparae, half of whom (n = 17) had been delivered previously by an unanticipated cesarean section and 4 women by elective cesarean. Seven women had experienced obstetrical complications during vaginal delivery. Five had a diagnosis of other serious medical conditions during the previous or the present pregnancy. The final parous woman demanded a cesarean in spite of perfect health and a normal previous delivery. The patients' reasons for demanding a cesarean, as understood from hospital records, were primarily a very serious fear of childbirth. A psychotherapeutically trained member of the obstetrical staff is well equipped to offer help. The impact of previous complicated birth is obvious in this study. Hopefully, we can avoid some future cesarean sections by means of better care for patients in crisis resulting from complicated childbirth.