Norwegian obstetricians’ opinions about cesarean section on maternal request: Should women pay themselves?Fuglenes D, Oian P, Gyrd-Hansen D, Olsen JA, Kristiansen IS (2010) 89: 1582-1588

Caesarean section on maternal request in the absence of any medical or obstetric indication has become an important issue in the wake of rising caesarean section rates in the Western world. There are studies that indicate that a c-section on maternal request is more costly than a vaginal delivery.

This study was aimed at exploring the obstetricians’ opinion on caesarean section on maternal request and their opinion regarding imposing a patient co-payment scheme.

All certified specialists of obstetrics in Norway as well as those in training were targeted. The study achieved a response rate of 71% (507 out of 716). They responded by filling a four-part seven-paged questionnaire. The participants were informed the additional cost of caesareans section to be around €3,700.

The majority of respondents (62%) considered patients’ request for a caesarean problematic from a clinical viewpoint, while 24% did not and 14% were neutral. The odds of considering such a situation problematic, were lower with increasing age and among male obstetricians (OR 0.63). Forty-nine percent of respondents were willing to perform a caesarean on maternal request while 28% were unwilling and 14% were uncertain. A higher acceptance rate was observed among certified specialists (OR 2.68) and obstetricians with an Eastern Europe origin (OR 3.23). Among those who would perform a caesarean section on maternal request, the most commonly states reason to accept such a request was the woman’s autonomy (68%) followed by to avoid lack of cooperation in labour (35%) and to avoid possible later complaints (14%). The cost of caesarean section was considered to be a public responsibility by 35%, while 32% did not and 33% were uncertain. Male obstetricians were more in favour of public funding than their female counterparts (OR 2.14).

Among all responders, 40% favoured patient co-payments with a median of €2,500. The proportion of female respondents in favour of patient co-payment was higher than the male respondents (64% vs. 37%, p<0.001) and the co-payment stated was significantly higher for the females than for males (€1,875 vs. €1,250, p<0.001).

Requests for caesarean section were perceived problematic by 60% of Norwegian obstetricians while around 50% were willing to agree to such a request and 40% were in favour of patient co-payments. There was a significant gender difference in their opinion about caesarean section for maternal request, and the attitude towards co-payment.

The high response rate (71%) among all specialists and trainees is an important strength of this study.