[Cesarean section on demand or elective. Cesarean section: request for rethinking]

Nowadays, the mortality and morbidity of caesarean section, particularly elective caesarean section, are hardly different from those of vaginal delivery. 'Section on request' is so extremely rare that it is of no importance and that these terms should not be used at all. A change in thinking is necessary because only real misgivings make the pregnant woman wish for this procedure. In this context, the increasing importance of autonomy and the right to self-determination of the woman lead to a fundamental shift in the relationship between doctor and patient. Long-term sequelae after vaginal delivery, e.g. injury to the pelvic floor with functional impairment and disturbances of sexual function, but also considerations about the safety of the child become more and more important for the pregnant woman and have to be taken seriously by the physician. Although there are no precise bases for assessment, a global comparison of costs between vaginal delivery and elective caesarean section with regard to the long-term sequelae will hardly show any true differences, and therefore the health insurances are not entitled to refuse the reimbursement of costs.