Obstetricians, health attorneys, and court-ordered cesarean sections

Despite court rulings suggesting that court-ordered cesarean sections should rarely be undertaken, they are performed. Our objective was to determine those characteristics of providers and patients that make their use more likely.

A convenience sample of obstetricians attending the annual meeting of the American College of Obstetricians and Gynecologists (n=229) and lawyers attending the annual meeting of the American Health Lawyers Association (n=126) read a vignette describing a woman who refused a cesarean section after being told that her fetus would die unless she received the operation. Several different scenarios were then described (e.g., the mother refused on religious grounds). For each scenario, participants were asked to rate the likelihood that they would support a court-ordered cesarean section. Participants then described their own characteristics.

Respondents were more likely to support a court order if the woman was described as a being "high on drugs" (p<.001). Respondents were significantly less likely to use a court order (p<.01) if the woman was described as a lawyer, the child had Down syndrome, the husband agreed with her decision, the mother refused on religious grounds, or the operation was associated with a 10-fold increased risk to the mother's life. People who described themselves as more religious, Republican, or "pro-life" were significantly more likely to utilize court orders in several scenarios. In an ordinal regression model, the degree of pro-life was the only variable consistently associated with obtaining a court order for the healthy mother-healthy child.

The perceived likelihood of performing a court-ordered cesarean section varies with characteristics of the patient and the provider.