title: Caesarean section on request: a comparison of obstetricians' attitudes in eight European countries.
abstract: OBJECTIVE
  To explore the attitudes of obstetricians to perform a caesarean section on maternal request in the absence of medical indication.
  
  
  METHODS
  Cluster sampling cross-sectional survey.
  
  
  METHODS
  Neonatal Intensive Care Unit (NICU) associated maternity units in eight European countries.
  
  
  METHODS
  Obstetricians with at least 6 months clinical experience.
  
  
  METHODS
  NICU-associated maternity units were chosen by census in Luxembourg, Netherlands and Sweden and by geographically stratified random sampling in France, Germany, Italy, Spain and UK. An anonymous, self-administered questionnaire was used for data collection.
  
  
  METHODS
  Obstetricians' willingness to perform a caesarean section on maternal request.
  
  
  RESULTS
  One hundred and five units and 1,530 obstetricians participated in the study (response rates of 70 and 77%, respectively). Compliance with a hypothetical woman's request for elective caesarean section simply because it was 'her choice' was lowest in Spain (15%), France (19%) and Netherlands (22%); highest in Germany (75%) and UK (79%) and intermediate in the remaining countries. Using weighted multivariate logistic regression, country of practice (P<0.001), fear of litigation (P= 0.004) and working in a university-affiliated hospital (P= 0.001) were associated with physicians' likelihood to agree to patient's request. The subset of female doctors with children was less likely to agree (OR 0.29, 95% CI 0.20-0.42).
  
  
  CONCLUSIONS
  The differences in obstetricians' attitudes are not founded on concrete medical evidence. Cultural factors, legal liability and variables linked to the specific perinatal care organisation of the various countries play a role. Greater emphasis should be placed on understanding the motivation, values and fears underlying a woman's request for elective caesarean delivery.
authors.affiliation: Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK. mah@le.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Habiba
authors.forename: M
authors.initials: M
authors.lastname: Kaminski
authors.forename: M
authors.initials: M
authors.lastname: Da Frè
authors.forename: K
authors.initials: K
authors.lastname: Marsal
authors.forename: O
authors.initials: O
authors.lastname: Bleker
authors.forename: J
authors.initials: J
authors.lastname: Librero
authors.forename: H
authors.initials: H
authors.lastname: Grandjean
authors.forename: P
authors.initials: P
authors.lastname: Gratia
authors.forename: S
authors.initials: S
authors.lastname: Guaschino
authors.forename: W
authors.initials: W
authors.lastname: Heyl
authors.forename: D
authors.initials: D
authors.lastname: Taylor
authors.forename: M
authors.initials: M
authors.lastname: Cuttini
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002585:Cesarean Section / Q000523:psychology*; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000523:psychology*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D010344:Patient Advocacy; D011247:Pregnancy