Patient choice cesarean: an evidence-based review.
Primary elective cesarean performed on a patient's request now comprises 4% to 18% of all cesareans and 14% to 22% of elective cesareans in reported series. Patients most commonly choose cesarean because of tocophobia, or fear of childbirth. Almost two thirds of obstetricians surveyed are willing to perform cesarean on request, citing decreased risk of pelvic floor or fetal injury, maintenance of sexual functioning, and physician and patient convenience. Contrasting these beliefs are the limited available data on short- and long-term maternal and perinatal morbidity and mortality that generally favor vaginal delivery. Moreover, comprehensive economic impact assessments of cesarean on request are lacking, and professional organizations do not agree on the ethics of offering patient choice cesarean.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader should be able to list the reasons that women and obstetricians choose elective cesarean delivery, to outline the ethical aspects of cesarean delivery, and to describe the material and fetal morbidity and mortality associated with cesarean delivery compared to vaginal delivery.
Maine Medical Center, Portland, USA. waxj@mmc.org
Joseph R
JR
Wax
Angelina
A
Cartin
Michael G
MG
Pinette
Jacquelyn
J
Blackstone
D001291:Attitude of Health Personnel; D001720:Birth Injuries / Q000517:prevention & control; D002585:Cesarean Section / Q000009:adverse effects / Q000941:ethics* / Q000401:mortality / Q000523:psychology; D002755:Choice Behavior; D019317:Evidence-Based Medicine; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D010358:Patient Participation; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011256:Pregnancy Outcome; D014549:Urinary Incontinence / Q000517:prevention & control