Correspondence: Elective caesarean section on request

Abstract

There is increased emphasis on patient choice in obstetric practice in the UK.1 Debate continues over whether elective caesarean section on request is justified.2,3 A structured anonymous postal survey revealed that 17% of obstetricians would prefer elective caesarean section if they or their partners were pregnant for the first time in an otherwise uncomplicated pregnancy.4 Female obstetricians were significantly more likely to prefer caesarean section than their male colleagues (31% vs. 8%). A recent survey of female midwives, however, showed only 4% would request caesarean section in similar circumstances.5 Suggested reasons for this difference included the greater exposure of midwives both to normal deliveries and to the relative difficulty a mother has nursing her baby after caesarean section. We wished to investigate the preferences of anaesthetists – another group of health care professionals intimately involved with obstetric patients. We conducted a structured anonymous postal survey of 90 anaesthetists within the East Anglia region – 50 specialist registrars and 40 consultant obstetric anaesthetists. Seventy-six questionnaires were returned (response rate 84%). Of these, 14% of anaesthetists would prefer elective caesarean section in the absence of any obstetric indication. Females appeared less likely than males to prefer elective caesarean section (8% vs. 15%), although this difference was not statistically significant. The reasons cited for preferring caesarean section were possible perineal damage during delivery (100%), long-term sequelae (100%), safe delivery of the fetus (82%), future sexual dysfunction (73%) and electively-timed delivery (45%). These results suggest that a similar proportion of anaesthetists and obstetricians are convinced of the merits of operative delivery. We also found that 33% of anaesthetists thought caesarean section on request should be available in the National Health Service (NHS), whilst 59% thought it should be available in the private sector. A third of anaesthetists felt caesarean section on request should be available in the NHS but over half were willing to accept the principle if funded privately. This implies that part, but by no means all of the objection to caesarean section on request is one of limited resources. It would appear that the majority of anaesthetists agree that caesarean section on request is not justified in an already overburdened NHS.