title: Caesarean section at maternal request--the differing views of patients and healthcare professionals: a questionnaire based study.
abstract: OBJECTIVE
  The number of caesarean sections at maternal request without medical indication is increasing. We aimed to explore the views of pregnant women, midwives and doctors using six hypothetical clinical scenarios and compare group views on: (a) perceived appropriateness of requests for caesarean section and (b) the reasons underlying these requests.
  
  
  METHODS
  A questionnaire was distributed to 166 pregnant women, 31 midwives and 52 doctors within maternity units at two hospitals in the North East region of England. Six hypothetical clinical scenarios for maternal requests were used: (1) uncomplicated first pregnancy, (2) one previous normal delivery, (3) one previous instrumental delivery, (4) one previous caesarean section, (5) one previous caesarean section with vaginal delivery since and (6) uncomplicated twin pregnancy. To highlight the differences in group responses, two main questions were asked for each scenario: 1. Should women be able to request a caesarean section? 2. What do you feel are the reasons for requesting a caesarean section? Data was analysed using Chi-squared or likelihood ratio as appropriate.
  
  
  RESULTS
  In scenarios 1-3, professional groups were 'less likely' than pregnant women to always support a request (2.4% vs. 19.4%), (2.6% vs. 15.6%), (4.6% vs. 22%), (p<0.001). No significant differences were shown between doctors and midwives except for scenario 6 (twins), where midwives more often felt maternal requests should be declined (26.1% vs. 1.9%) (p=0.001). Multiparous women (n=95) were more likely to agree 'sometimes' to maternal requests in scenarios 1, compared to nulliparous women (n=71) (21.1% vs. 4.2%) (p=0.04). 'Safety of the baby' was ranked highly with pregnant women in scenarios 1-3 (mean 24.4%, range [15.8-38%]) compared with healthcare professionals (7.6% [3.4-12.8%]). However in scenario 3, healthcare professionals attributed 'fear of injury to self' (29.6%) as the most likely reason compared to 14.6% of pregnant women.
  
  
  CONCLUSIONS
  Healthcare professionals and pregnant women's views differ significantly. Multiparous patients' views differ from those who have not had children before. We should provide clearer information on risks and benefits which encompass areas that concern women most.
authors.affiliation: South Tees NHS Foundation Trust, Newcastle University, Newcastle upon Tyne, Tyne and Wear NE1 7RU, United Kingdom. Electronic address: Abigail.sharpe@newcastle.ac.uk.
authors.forename: A N
authors.initials: AN
authors.lastname: Sharpe
authors.affiliation: City Hospitals Sunderland NHS Foundation Trust, United Kingdom.
authors.forename: G J
authors.initials: GJ
authors.lastname: Waring
authors.affiliation: University of Sunderland, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Rees
authors.affiliation: Department of Pharmacy, Health and Well-being, Faculty of Applied Science, University of Sunderland, SR1 3RG, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: McGarry
authors.affiliation: City Hospitals Sunderland NHS Foundation Trust, SR4 7TP, United Kingdom; Department of Pharmacy, Health and Well-being, University of Sunderland, SR1 3SD, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Hinshaw
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000523:psychology*; D003657:Decision Making; D036861:Delivery, Obstetric / Q000523:psychology; D017558:Elective Surgical Procedures / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D008875:Middle Aged; D008880:Midwifery; D009774:Obstetrics; D010298:Parity; D057240:Patient Preference / Q000523:psychology*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Caesarean section; Doctors; Maternal request; Midwives; Pregnant women