title: Cesarean by choice? Empirical study of public attitudes.
abstract: OBJECTIVE
  This study examines public attitudes towards maternal requests for cesarean delivery and its association with health care and birth experiences. In addition, this study attempts to ascertain whether gender, age and residence influence these attitudes.
  
  
  METHODS
  Cross-sectional population survey with a postal questionnaire.
  
  
  METHODS
  The counties of Stockholm and Vasterbotten in Sweden.
  
  
  METHODS
  Equal numbers of women and men between 20 and 80 years of age (n=2,000) by population size and gender distribution.
  
  
  METHODS
  Descriptive statistics and content analysis.
  
  
  RESULTS
  Of the 1,066 women (53%) who responded, two-thirds stated that a cesarean should be decided on for medical reasons and by a doctor. One-third considered that a woman, without persuasion, should decide herself about mode of delivery and should be free to choose a cesarean. These respondents used arguments such as women's rights, bodily integrity and childbirth fear. The results were associated with low trust in health care, women being young or middle aged, urban living and having no children. Low trust in health care was associated with experiences of insecurity, vulnerability and perceived maltreatment.
  
  
  CONCLUSIONS
  Public norms towards women's own decision making on mode of delivery are associated with younger age, lower trust in health care and urban living. Antenatal care will encounter more parents asking for a cesarean and demanding that health professionals provide an ethically appropriate informed consent process. Considering the risk of violating young women's trust if not respecting her wish, it seems reasonable that making decisions whether or not to perform a cesarean is part of shared decision making.
authors.affiliation: Obstetrics and Gynecology, Department of Clinical Science, Umeå University, Umeå, Sweden. ulf.hogberg@obgyn.umu.se
authors.forename: Ulf
authors.initials: U
authors.lastname: Högberg
authors.forename: Niels
authors.initials: N
authors.lastname: Lynöe
authors.forename: Marianne
authors.initials: M
authors.lastname: Wulff
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002585:Cesarean Section; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D011247:Pregnancy; D011639:Public Opinion; D011795:Surveys and Questionnaires; D013548:Sweden; D014933:Women's Rights