Should doctors perform an elective caesarean section on request?

Abstract

The incidence of caesarean sections performed on request without medical indications is rising. The reasons for this are not only for perceived medical benefit, but are also due to social, cultural and psychological factors. Despite dramatic improvements in the safety of anaesthesia and surgery, mortality and morbidity are greater for elective caesarean sections compared to vaginal deliveries. An association exists between pelvic floor damage and childbirth, but this cannot be attributed entirely to vaginal deliveries and does occur even after a caesarean birth. The incidence of late intrauterine deaths is unlikely to be reduced by a policy of universal elective caesarean section, as these procedures carry a risk of iatrogenic fetal morbidity and mortality. The legal and ethical issues of request caesarean sections are complex. The validity of informed consent for non-indicated surgery is unclear. An individual has his/her rights and so does society. When society's rights are judged to have priority, the individual's right becomes a privilege. Based on this principle, maternal request caesarean sections must not compromise the provision of care to women requiring medically-indicated caesarean sections or should not dent the resources of public healthcare. In dealing with requests for caesarean sections, obstetricians should establish the reasons for the request and provide clear, unbiased information based on the best available evidence. Individualized modifications to the management of labour may allow some women to have vaginal deliveries. A second opinion from a colleague may help the patient to reconsider the request and make a more informed choice.