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Caesarean section on maternal request - a qualitative study of stakeholders´ views
Maria Johansson Offerman1, Inger K Holmström2,3, Mio Fredriksson3
1School of Health, Care and Social Welfare, Division of Caring Sciences and Health Care Pedagogics, Mälardalen University, Box 883, Västerås, 721 23, Sweden. Maria.johansson.offerman@mdu.se.
Reproductive Health
|November 29, 2025
Summary
Stakeholders view caesarean section on maternal request (CSMR) as a valid choice despite risks, emphasizing informed decision-making and continuity of care. Addressing distrust and resource allocation are key to equitable maternity services.
Area of Science:
- Maternal Health
- Healthcare Policy
- Bioethics
Background:
- Caesarean section on maternal request (CSMR) presents ethical and clinical challenges in Sweden.
- Existing research on CSMR primarily focuses on women and healthcare providers, with limited insight into stakeholder perspectives.
- Regional variations in Sweden suggest potential inequities in care provision for CSMR.
Purpose of the Study:
- To investigate the views of Swedish healthcare stakeholders on CSMR.
- To explore stakeholder perspectives on CSMR in relation to medical considerations, individual autonomy, and societal values.
Main Methods:
- Qualitative study employing a reflexive thematic analysis approach.
- Semi-structured interviews were conducted with 16 key stakeholders.
- Participants included regional politicians, policymakers, national authority representatives, and organizational representatives.
Main Results:
- CSMR is viewed as a legitimate option for some women, with medical risks acknowledged but not always disqualifying.
- Decision-making processes for CSMR are complex, with a strong emphasis on the need for support, guidance, and emotional continuity of care.
- Distrust in maternity care is linked to media representation and inconsistent CSMR handling; economic concerns involve resource allocation and public healthcare scope.
- Private payment for planned caesarean sections was broadly rejected.
Conclusions:
- CSMR is a complex issue with varied perspectives on individual and population-level risks.
- Informed decision-making, incorporating medical and psychological risks with crucial counseling, is essential.
- Continuity of midwife care models may serve as an alternative to CSMR for some women.
- Stakeholder engagement is vital for establishing clear guidelines, ensuring equitable care, and fostering trust in the healthcare system.
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