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Most obstetricians are reluctant to grant women a first-time cesarean delivery without medical indications

A growing number of women are asking their obstetricians to delivery their baby by cesarean section instead of vaginally, even though there is no medical reason to do so. Some women want the convenience of scheduling the delivery, while others are tired of being pregnant and want to get it over with.

A recent study found that most obstetricians are reluctant to agree to these requests, but male physicians are more likely than female physicians to respond favorably, especially for patients in a higher socioeconomic bracket. The study was supported by the Agency for Healthcare Research and Quality (HS11338).

Jeanne-Marie Guise, M.D., M.P.H., and colleagues at the Oregon Evidence-based Practice Center analyzed survey responses of 140 obstetrician-gynecologists in the Portland, OR, area in 2000. Physicians were asked to respond to 17 clinical scenarios involving a patient at term with a single pregnancy requesting a first-time cesarean delivery in spite of her obstetrician's recommendation for vaginal delivery. Of those surveyed, 68 to 98 percent agreed to cesarean delivery in cases with a clear medical indication—for example, a woman in early labor with placenta previa (the placenta is close to the opening of the cervix, which can cause severe bleeding during delivery).

Without a clear medical indication, for example, a woman in early labor who feared becoming incontinent after vaginal delivery, most of the physicians would not perform a cesarean delivery. In cases where medical indications were unclear, such as a woman in early labor with a history of prior 4th degree laceration, responses were divided.

Male physicians were significantly more likely than female physicians to agree to perform a cesarean delivery for a woman reporting concern for future urinary incontinence (29 vs. 9 percent) or history of prior stillbirth (24 vs. 4.5 percent). However, when cesarean delivery was medically indicated, there was no difference in agreement between female and male physicians.

More details are in "Physicians' responses to patient-requested cesarean delivery," by Chiara Ghetti, M.D., Benjamin K. Chan, M.S., and Dr. Guise, in the December 2004 BIRTH 31(4), pp. 280-284.

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