title: Patient-initiated elective cesarean section of nulliparous women in British Columbia, Canada.
abstract: BACKGROUND
  The proportion of cesarean sections is increasing in Canada overall and in British Columbia in particular. It has been suggested that this increase is partially the result of women requesting the procedure, although the prevalence of patient-initiated elective cesarean section is unclear. The objective of this study was to examine the prevalence of probable elective cesarean and physician-suggested elective cesarean section among nulliparous women who had a cesarean section in British Columbia, Canada.
  
  
  METHODS
  An electronic search of patient charts from seven British Columbia hospitals between June 1, 2002, and May 31, 2004, was completed and potential nulliparous women seeking elective cesarean were identified. Any women with medical factors predisposing them to a cesarean section were excluded. Identified charts were then subjected to individual chart review by two independent researchers to ensure accuracy of classification into a cohort of women with probable patient-initiated elective cesarean section.
  
  
  RESULTS
  For the study period, 10,546 nulliparous women gave birth at the seven study hospitals and 3,301 delivered by means of cesarean section. Of these 3,301 women, 36 were judged to have had a patient-initiated elective cesarean. These 36 women represented 0.34 percent of all nulliparous births and 1.09 percent of all nulliparous cesarean births. Those judged to have selected an elective cesarean were significantly older and had babies with a lower gestational age than women with a nonelective cesarean section. No significant differences between the two groups were found with respect to maternal weight, length of stay for the mother or baby, newborn birthweight, or special care nursery days.
  
  
  CONCLUSIONS
  Overall, the prevalence of nulliparous women judged to have had a patient-initiated elective cesarean was found to be low and is not likely to be substantially contributing to the rising proportion of cesarean births.
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
authors.forename: Jude
authors.initials: J
authors.lastname: Kornelsen
mesh_terms: D000328:Adult; D000367:Age Factors; D000886:Anthropometry / Q000379:methods*; D001724:Birth Weight; D001955:British Columbia; D002585:Cesarean Section / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D002755:Choice Behavior; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D010298:Parity; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data; D011247:Pregnancy; D015995:Prevalence