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Cesarean Delivery on Maternal Request

Obstetrician–Gynecologists’ Knowledge, Perception, and Practice Patterns

From the ¹Department of Research, the American College of Obstetricians and Gynecologists, Washington, DC; ²Department of Research, the American College of Obstetricians and Gynecologists and Department of Psychology, American University, Washington, DC; ³Division of Practice Activities, the American College of Obstetricians and Gynecologists, Washington, DC; ⁴Pregnancy and Perinatology Branch and ⁵Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland; and ⁶Washington, DC.

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

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