title: Physicians' responses to patient-requested cesarean delivery.
abstract: BACKGROUND
  The issue about whether a woman's autonomy in childbirth should include the choice of cesarean delivery in the absence of medical indications has become a major source of debate. Our objective was to examine factors that determined physicians' responses to patient-requested cesarean delivery.
  
  
  METHODS
  Surveys were distributed to all obstetrician-gynecologists in the greater Portland, Oregon, metropolitan area in Spring, 2000. Physicians were asked to respond to scenarios involving a term patient with a singleton pregnancy requesting primary cesarean delivery.
  
  
  RESULTS
  One hundred and seventy of 255 physicians (67%) responded, of whom 68 to 98 percent agreed to cesarean delivery in cases with clear medical indications. Without a clear medical indication, most practitioners would not perform a cesarean delivery. In cases where medical indications were unclear, responses were divided. Physician male gender and patient high socioeconomic status were associated with increased likelihood of physician agreement to patient-requested cesarean delivery. Age, years in practice, and practice type were not associated with agreement.
  
  
  CONCLUSIONS
  Physicians are reluctant to agree to patient request for primary cesarean delivery without a clear medical indication. Male physicians were more likely to agree to a patient's request for cesarean delivery than female physicians.
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, 97239-3098, USA.
authors.forename: Chiara
authors.initials: C
authors.lastname: Ghetti
authors.forename: Benjamin K S
authors.initials: BK
authors.lastname: Chan
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Guise
mesh_terms: D000328:Adult; D000368:Aged; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D009922:Oregon / Q000453:epidemiology; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014504:Urban Health