• M Habiba, M Kaminski, M Da Frè, K Marsal, O Bleker, J Librero, H Grandjean, P Gratia, S Guaschino, W Heyl, D Taylor, and M Cuttini.
• Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK. mah@le.ac.uk
• BJOG. 2006 Jun 1; 113 (6): 647-56.

ObjectiveTo explore the attitudes of obstetricians to perform a caesarean section on maternal request in the absence of medical indication.DesignCluster sampling cross-sectional survey.SettingNeonatal Intensive Care Unit (NICU) associated maternity units in eight European countries.PopulationObstetricians with at least 6 months clinical experience.MethodsNICU-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 MeasuresObstetricians' willingness to perform a caesarean section on maternal request.ResultsOne 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).ConclusionsThe 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.

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