[Cesarean section on request because of labor pain--bioethical and legal views]

Non-medical reasons that influence the decision to perform cesarean section are the subject of numerous medical and bioethical debates. The questions to be answered are: can a pregnant woman demand cesarean section based on her right to make decisions, i.e. on patient rights? Do such a request and permission given by the woman justify the physician to perform the procedure without clear medical indication, knowing that cesarean section is associated with higher maternal morbidity and mortality rate than vaginal delivery? Among the numerous reasons stated by pregnant women or their families when demanding cesarean section, this paper is focused on labor pain. The experience of pain during delivery is the result of many complex physiologic and psychosocial factors that act on the woman's personal interpretation of the nociceptive delivery stimuli. A mother's request for cesarean section should not be motivated by the lack of efficiency of pain management. Such motivation points to inadequate prenatal care and patient education offered by the obstetrician and anesthesiologist. Decisions to perform cesarean section upon request are not in accordance with the guidelines of declarations and codes of medical ethics, and have no legal basis in our country.