Caesarean Section on Maternal Request: An Italian Comparative Study on Patients’ Characteristics, Pregnancy Outcomes and Guidelines Overview

Abstract

In recent years, the rate of caesarean sections has risen all over the world. Accordingly, efforts are being made worldwide to understand this trend and to counteract it effectively. Several factors have been identified as contributing to the selection of caesarean section (CS), especially an obstetricians’ beliefs, attitudes and clinical practices. However, relatively few studies have been conducted to understand the mechanisms involved, to explore influencing factors and to clearly define the risks associated with the caesarean section on maternal request (CSMR). This comparative study was conducted to elucidate the factors influencing the choice of CSMR, as well as to compare the associated risks of CSMR to CS for breech presentation among Italian women. From 2015 to 2018, a total of 2348 women gave birth by caesarean section, of which 8.60% (202 women) chose a CSMR. We found that high educational attainment, use of assisted reproductive technology, previous operative deliveries and miscarriages within the obstetric history could be positively correlated with the choice of CSMR in a statistically significant way. This trend was not confirmed when the population was stratified based on patients’ characteristics, obstetric complications and gestational age. Finally, no major complications were found in patients that underwent CSMR. We believe that it is essential to evaluate patients on a case-by-case basis. It is essential to understand the personal experience, to explain the knowledge available on the subject and to ensure a full understanding of the risks and benefits of the medical practice to guarantee the patients not only their best scientific preparation but also human understanding.

Immigration and Adverse Pregnancy Outcomes in an Italian Free Care Hospital

“…29,30 This could be due to the fact that the rate of vaginal delivery after CS is extremely low in our Department, while repeated CS reach up to 30% of all CS and the rate of primary CS on maternal request is around 8.6%. 31 Obstetricians should discourage the policy to routinely perform elective CS after a previous one or upon maternal request without an appropriate indication and adequately counsel patients regarding the risks of cesarean sections over vaginal delivery. Controversial data exist in the literature concerning the differences on the CS rate between native and immigrant population.…”

Comparison of Labor and Delivery Complications and Delivery Methods Between Physicians and White-Collar Workers

“…These cumulative exposures may influence women’s reproductive health, which may increase risks of spontaneous abortion, reduced intrauterine growth, preterm delivery, and low birth weight [ 8 , 11 , 12 ]. Several obstetric conditions such as prior cesarean delivery, maternal anemia, gestational diabetes, abnormal presentations, placenta previa, placental abruption, and prematurity were related to an increased use of cesarean deliveries [ 21 ]. Thus, we considered the possibility that physicians might have been exposed to occupational and environmental hazards during labor and delivery, which may have contributed to the results.…”

A brief history and indications for cesarean section

“…50 Higher educational achievement, use of assisted reproductive technology, history of previous operative childbirth, and miscarriages are found to be significantly associated with the CS on maternal request. 55 The guidelines for counseling and treatment regarding maternal requests suggest that the request for a CS is appropriate to consider if a woman persists in her request after counseling with enough serious reasons. 56 In the hospital situation, the medical expertise and authority of doctors can influence a woman to choose a CS.…”