Intrapartum elective cesarean delivery: a previously unrecognized clinical entity

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Obstetrics

Background:

• Intrapartum elective cesarean delivery, defined as cesarean delivery offered by a physician or requested by a patient before a clear medical indication, is a recognized clinical entity.
• Understanding the factors influencing these decisions is crucial for optimizing obstetric care and patient outcomes.

Purpose of the Study:

• To investigate the incidence of intrapartum patient-choice cesarean delivery.
• To identify factors influencing physician offers and patient requests for cesarean delivery during labor.

Main Methods:

• A 6-month prospective study (May-October 2002) involving 422 intrapartum cesarean deliveries.
• Obstetricians completed questionnaires regarding cesarean delivery offers/requests prior to medical indication.
• Patient medical records and physician demographics were reviewed.

Main Results:

• Cesarean delivery was offered in 13% and requested in 8.8% of cases before a clear medical indication.
• Older obstetricians, maternal-fetal medicine specialists, and full-time faculty were more likely to offer cesarean delivery.
• Unmarried patients and those undergoing labor induction were less likely to request cesarean delivery.

Conclusions:

• Physician characteristics are major determinants in offering intrapartum elective cesarean delivery.
• Patient characteristics and intrapartum factors did not significantly influence the offer or request for cesarean delivery.
• This study highlights the need to examine physician-specific factors in cesarean delivery decision-making.