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Intrapartum Elective Cesarean Delivery: A Previously Unrecognized Clinical Entity

Robin B. Kalish, MD^*, Laurence McCullough, PhD^*, Meruka Gupta^*, Howard T. Thaler, PhD and Frank A. Chervenak, MD^*

From the *Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York; Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; and Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.

Address reprint requests to: Robin B. Kalish, MD, Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, 525 East 68th Street, Room J-130, New York 10021; e-mail: robinkal{at}aol.com.

OBJECTIVE: The purpose of the study was to investigate the incidence of intrapartum patient choice cesarean delivery—patients’ requesting cesarean delivery and physicians’ offering it during labor—and factors possibly influencing these requests and offers.

METHODS: For a 6-month period from May 1, 2002, to October 31, 2002, obstetricians were asked to complete a questionnaire after all intrapartum cesarean deliveries regarding whether cesarean delivery was offered by the obstetrician or requested by the patient before being medically indicated. Patient medical records and physician demographic information were reviewed.

RESULTS: There were 422 cases that met inclusion criteria. Questionnaires were completed in 100% of cases. Cesarean delivery was offered in 13% before a clear medical indication and requested in 8.8%. Older obstetricians, maternal–fetal medicine specialists, and full-time faculty were significantly more likely to offer cesarean delivery (P = .009, P < .001, and P = .015, respectively). Patients who were unmarried or undergoing labor induction were less likely to request cesarean delivery (P = .029 and P = .035, respectively). Maternal age, parity, stage or length of labor, epidural use, gestational age, insurance status, day of week, and time of delivery did not affect whether patients requested or were offered cesarean delivery.

CONCLUSION: This study documents a heretofore unrecognized clinical entity: intrapartum elective cesarean delivery. Physician characteristics, as opposed to patient characteristics or intrapartum factors, are a major determinant of whether laboring patients are being offered cesarean delivery.

LEVEL OF EVIDENCE: III

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