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Updated: Aug 8, 2026
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Published on: June 6, 2020
Caesarean section on request: a comparison of obstetricians' attitudes in eight European countries
M Habiba1, M Kaminski, M Da Frè
1Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK. mah@le.ac.uk
Objective:
To explore the attitudes of obstetricians to perform a caesarean section on maternal request in the absence of medical indication.
Design:
Cluster sampling cross-sectional survey.
Setting:
Neonatal Intensive Care Unit (NICU) associated maternity units in eight European countries.
Population:
Obstetricians with at least 6 months clinical experience.
Methods:
NICU-associated maternity units were chosen by census in Luxembourg, Netherlands and Sweden and by geographically stratified random sampling in France, Germany, Italy, Spain and UK. An anonymous, self-administered questionnaire was used for data collection.
Main Outcome Measures:
Obstetricians' willingness to perform a caesarean section on maternal request.
Results:
One hundred and five units and 1,530 obstetricians participated in the study (response rates of 70 and 77%, respectively). Compliance with a hypothetical woman's request for elective caesarean section simply because it was 'her choice' was lowest in Spain (15%), France (19%) and Netherlands (22%); highest in Germany (75%) and UK (79%) and intermediate in the remaining countries. Using weighted multivariate logistic regression, country of practice (P<0.001), fear of litigation (P= 0.004) and working in a university-affiliated hospital (P= 0.001) were associated with physicians' likelihood to agree to patient's request. The subset of female doctors with children was less likely to agree (OR 0.29, 95% CI 0.20-0.42).
Conclusions:
The differences in obstetricians' attitudes are not founded on concrete medical evidence. Cultural factors, legal liability and variables linked to the specific perinatal care organisation of the various countries play a role. Greater emphasis should be placed on understanding the motivation, values and fears underlying a woman's request for elective caesarean delivery.
