Physicians??? Responses to Patient-requested Cesarean Delivery

Abstract

Argument continues about whether women should be empowered to choose cesarean delivery even if there is no medical indication. This survey, distributed in the year 2000 to all obstetrician-gynecologists in the Portland, Oregon, area, was designed to ascertain what determines physicians' responses to 17 scenarios involving a term patient with a singleton pregnancy who requested primary cesarean delivery. Two thirds of the physicians, numbering 170, responded; 140 of them, whose mean age was 47 years, were currently in practice and had been for 15 years on average. More than 90% of physicians agreed to cesarean delivery in 4 of the 5 cases with clear medical indications. In contrast, most practitioners did not agree to surgery when there were no medical indications. When medical indications were not clear, responses were divided. Male respondents were significantly likelier than females to agree to perform a cesarean delivery when a woman was concerned about future urinary incontinence or had a history of stillbirth. With no medical indications, female physicians were less likely than men to agree to cesarean delivery. After adjusting for physician-related factors, respondents were more likely to agree with a request from a high-socioeconomic-status woman. The physicians' responses were not significantly associated with their age, years in practice, or type of practice. Physicians do not readily agree to a patient's request for cesarean delivery unless there is a clear medical indication for the procedure. This is especially the case for female physicians.