Caesarean section on request: are there loco-regional factors influencing maternal choice? An Italian experience

We aimed to evaluate regional differences in women's motivations and in obstetricians' attitudes re 'caesarean section on request' between obstetricians practicing in Southern and Northern Italy. An anonymous questionnaire was sent to 70 randomly selected specialists practicing in the Veneto region and Sicily. Demographic characteristics, percentage of caesarean section, increase of caesarean section on demand, maternal motivations and the role played by anxiety, relatives and instrumental examinations were analysed. Moreover, obstetricians' opinion and their behaviour in fulfilling, or not, the maternal request were evaluated. Among the emotional reasons, fear of pain was more frequently reported in Sicily (p = 0.045), and previous negative experiences and gestational anxiety in the Veneto region (p = 0.009; p = 0.001). As regards instrumental examinations influencing maternal request, a significant difference was found for ultrasonography (28% in Sicily vs 60% in Veneto, p = 0.002). The husband's role was more frequently reported in the Veneto region (p = 0.006). Obstetricians of both regions noticed a rising rate of caesarean section on maternal request. The reasons for this upward trend are complex, vary from one region to another and are influenced by local socio-cultural and healthcare background.