Bewley S, Cockburn J The unethics of ‘request’ caesarean section. BJOG. 2002; 109:593-6

Gass CWJ It is the right of every anaesthetist to refuse to participate in a maternal-request caesarean section. Int J Obstet Anesth. 2006; 15:(1)33-7

Latham SR, Norwitz ER Ethics and ‘Cesarean Delivery on Maternal Demand’. Semin Perinatol. 2009; 33:(6)405-9

Macfarlane AJ, Blondel B, Mohangoo AD Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG. 2015;

Nzewi C, Penna LK Caesarean section for maternal request. Obstet Gynaecol Reprod Med. 2011; 21:(11)327-8

Penna L, Arulkumaran S Cesarean section for non-medical reasons. Int J Gynaecol Obstet. 2003; 82:(3)399-409

WHO Statement on Caesarean Section Rates.Geneva: WHO; 2015

The ethics behind caesarean section

02 May 2015
Volume 23 · Issue 5

The World Health Organization recommends that the ideal rate for caesarean sections should be between 10 and 15%. However, caesarean sections have become increasingly common in both developed and developing countries (WHO, 2015).

A recent survey by Macfarlane et al (2015) found caesarean section rates ranging from 14.8% (Iceland) to 24.6% (England) to 52.2% (Cyprus), with a median rate of 25.2%. By contrast, instrumental vaginal delivery rates ranged from 0.5% (Romania) to 12.6% (England) to 16.4% (Ireland), with a median rate of 7.5%. These variations, the authors conclude, illustrate a lack of consensus about practice and raise questions for further investigation.

Macfarlane et al's (2015) data support the contention of Penna and Arulkumaran (2003: 399) that obstetricians are ‘… more likely to agree to a request for a non-medically indicated caesarean section than in the past’, citing a 1986 study showing that most obstetricians refused to perform unnecessary caesareans; but in 1998 another study found that 69% complied with such requests.

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