title: Patient choice cesarean--the Maine experience.
abstract: BACKGROUND
  Patient choice cesarean refers to elective primary cesarean in the absence of a medical or obstetrical indication. The purpose of this study was to determine obstetricians' attitudes and practices with respect to patient choice cesarean in Maine, United States.
  
  
  METHODS
  A questionnaire was sent to all Maine Fellows of the American College of Obstetricians and Gynecologists actively practicing obstetrics, after receiving institutional review exemption. Data were analyzed using descriptive statistics, Fisher exact, or chi-square tests.
  
  
  RESULTS
  Seventy-eight of 110 (70.9%) obstetricians responded. Of these, 60 of 71 (84.5%) respondents performed or were willing to perform patient choice cesarean. However, 15 of 71 (21.1%) preferred a cesarean delivery for themselves (women) or partners (men). Indications included urinary continence (53.3%), adverse previous birth experience (41.7%), anal continence (35.0%), concern for fetal death or injury (33.3%), and fear of childbirth, preservation of sexual function, or pelvic organ prolapse (26.7% each). Less frequent were pain (11.7%), convenience (8.3%), and provider availability (10.0%). In addition, 82.1 percent believed medical evidence and 85.9 percent believed ethical issues sometimes or always supported patient choice cesarean. Responses were similar by gender, age, and time interval from training completion with two exceptions. Women under age 35 years were more likely to opt for a cesarean delivery themselves (p = 0.04), and 42.9 percent of respondents under age 35 years interpreted the medical literature as supporting cesarean in all cases versus 4.2 percent of older colleagues (p = 0.008). Sixty-four of 78 (82.1%) respondents would find a randomized trial of planned vaginal versus planned cesarean delivery helpful in addressing the issue of patient choice cesarean.
  
  
  CONCLUSIONS
  Although Maine obstetricians were willing to perform patient choice cesarean, few preferred this delivery mode for themselves or their partners. A randomized trial of planned vaginal versus planned cesarean delivery is highly desired.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine, United States.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Wax
authors.forename: Angelina
authors.initials: A
authors.lastname: Cartin
authors.forename: Michael G
authors.initials: MG
authors.lastname: Pinette
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Blackstone
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000706:statistics & numerical data; D003657:Decision Making; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008281:Maine; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D010358:Patient Participation / Q000523:psychology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy