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Caesarean section on request: a survey in The Netherlands
Anneke Kwee1, Ben J Cohlen, Humphrey H H Kanhai
1Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, WKZ, KE.04.123.1, Lundlaan 6, 3584 EA Utrecht, The Netherlands. a.kwee@azu.nl
Summary
Dutch gynecologists show varied willingness to perform caesarean sections on request. Experienced doctors and those who understand patient fear are more likely to agree, highlighting a need for clear guidelines on elective procedures.
Area of Science:
- Obstetrics and Gynecology
- Medical Ethics
- Patient Autonomy
Background:
- Elective caesarean sections (CS) requested by patients without clear medical indications present an ethical and clinical challenge.
- Understanding the perspectives of healthcare providers is crucial for developing appropriate management strategies.
Purpose of the Study:
- To assess the attitudes of Dutch gynecologists and registrars regarding patient-requested caesarean sections.
- To identify factors influencing their willingness to perform non-medically indicated CS.
Main Methods:
- An anonymous postal survey was distributed to 900 Dutch gynecologists and registrars.
- The survey included eight simulated cases with varying reasons for elective CS requests.
- Data were analyzed using logistic regression to identify influencing factors.
Main Results:
- The response rate was 65%, with willingness to perform elective CS ranging from 17% to 81% across cases.
- Key reasons for acceptance included patient autonomy, fear, and potential litigation.
- Experienced doctors were more willing than less experienced ones; doctor's sex and training institution had no influence.
Conclusions:
- A significant willingness exists among Dutch gynecologists to perform caesarean sections for non-medical reasons.
- Doctor's experience and perceived patient fear influence acceptance.
- There is a clear need for standardized guidelines to manage requests for elective caesarean sections.