Estimating the rate of cesarean section by maternal request: anonymous survey of obstetricians in Australia.
BACKGROUND
The rate of cesarean section in Australia now exceeds 30 percent, and evidence from population studies indicates that maternal requests for elective cesarean delivery might make an important contribution. The objective of this study was to explore the rate of such deliveries in Australia, in the absence of a formal investigation.


METHODS
An anonymous survey was sent to all 1,239 specialist obstetricians and 317 obstetric specialty trainees in Australia. Specialists were asked the number of elective cesarean deliveries they performed in 2006 that satisfied the National Institutes of Health definition of maternal request cesarean delivery. Trainees were asked whether they intended to agree to maternal requests for cesarean section in their future specialist practice.


RESULTS
The response rate from specialists was 98.6 percent, and from trainees was 81 percent. To account for possibility of multiple submissions, we performed two analyses: one using all responses, the other after removing 297 surveys in the second mail-out that were identical to surveys received from the first mail-out (n = 735). Proportions were similar in both groups. We estimated that between 8,553 and 12,434 maternal request cesarean sections were performed in Australia in 2006, representing at least 17 percent of all elective cesarean sections, and slightly more than 3 percent of all births.


CONCLUSIONS
Maternal request is an important contributor to cesarean section rates in Australia.
Robson
Stephen J
SJ
Australian National University's Medical School in Canberra, Canberra, Australia.
Tan
Woo Syong
WS
Adeyemi
Adebayo
A
Dear
Keith B G
KB
D001291:Attitude of Health Personnel; D001315:Australia; D001723:Birth Rate / Q000639:trends; D002585:Cesarean Section / Q000523:psychology / Q000706:statistics & numerical data*; D003299:Cooperative Behavior; D017558:Elective Surgical Procedures / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000193:education / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D018579:Patient Selection; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011365:Professional Practice Location / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D019564:Unnecessary Procedures / Q000706:statistics & numerical data