Boerma T, Ronsmans C, Melesse DY Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018; 392:1341-48

Eide KT, Bærøe K. How to reach trustworthy decisions for caesarean sections on maternal request: a call for beneficial power. J Med Ethics. 2021; 47

Gee H. Caesarean section should be available on request. BJOG. 2015; 122:(3)359-360

HSCC. Oral evidence: Safety of maternity services in England, HC 677. 2021. (accessed 22 February 2022)

National Institute for Health and Care Excellence. Caesarean birth. 2021. (accessed 4 March 2022)

Romanis EC. Appropriately framing maternal request caesarean section. J Med Ethics. 2022;

Caesarean sections and ethics

02 April 2022
Volume 30 · Issue 4


George F Winter examines the ethics surrounding a woman's request for a caesarean section when it is not medically indicated

According to the UK's National Institute for Health and Care Excellence (2021), 25–30% of women have a caesarean section. On a global scale, Boerma et al (2018) note that in 2015, caesarean section accounted for an estimated 29.7 million (21.1%) of 140.6 million live births, an increase from 16.0 million (12.1%) of 131.9 million livebirths in 2000, and they cite ‘strong evidence of overuse of caesarean section (ie beyond what is medically necessary) in all parts of the world.’

In Europe, the lowest willingness to comply with maternal requests and attitudes toward maternal autonomy is found in Spain and France, and the highest willingness to comply is found in the UK and Germany (Eide and Bærøe, 2021). However, the nature of autonomy is open to discussion, with Eide and Bærøe (2021) citing evidence for the view that an autonomous decision must be intentional and the result of deliberation that takes account of relevant information, with the individual free from adverse influences like coercion and deception. However, in medical practice ‘the patient may not have a right to choose treatment outside of the “healthcare menu” as defined by the healthcare professionals and/or policymakers…[so that] a woman cannot demand a planned caesarean section unless a physician finds it medically indicated’ (Eide and Bærøe, 2021).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month