title: Attitudes of midwives in Sweden toward a woman's refusal of an emergency cesarean section or a cesarean section on request.
abstract: BACKGROUND
  A woman's refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician's decision making in relation to a woman's refusal of an emergency cesarean section and to a woman's request for a cesarean section without a medical indication.
  
  
  METHODS
  The study has a cross-sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259).
  
  
  RESULTS
  In the case of a woman's refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman's request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman's decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman's autonomy in this situation. If the only reason was "her own choice," 77 percent of the midwives responded that the obstetrician should not comply.
  
  
  CONCLUSIONS
  The main focus of midwives seems to be the baby's health, and therefore they do not always agree with respect to a woman's refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician.
authors.affiliation: Department of Health Sciences, Faculty of Medicine, University Lund, Lund, Sweden.
authors.forename: Margaretha
authors.initials: M
authors.lastname: Danerek
authors.forename: Karel
authors.initials: K
authors.lastname: Maršál
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
authors.forename: Göran
authors.initials: G
authors.lastname: Lingman
authors.forename: Tore
authors.initials: T
authors.lastname: Nilstun
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Dykes
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000523:psychology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003657:Decision Making; D004630:Emergencies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008880:Midwifery / Q000379:methods*; D024802:Nurse's Role / Q000523:psychology*; D009723:Nurse-Patient Relations; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult