Habiba M, Kaminski M, Da Frè M, Marsal K, Bleker O, Librero J, Grandjean H, Gratia P, Guaschino S, Heyl W, Taylor D, Cuttini M
Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK.
BJOG. 2006 Jun;113(6):647-56. doi: 10.1111/j.1471-0528.2006.00933.x.
To explore the attitudes of obstetricians to perform a caesarean section on maternal request in the absence of medical indication.
Cluster sampling cross-sectional survey.
Neonatal Intensive Care Unit (NICU) associated maternity units in eight European countries.
Obstetricians with at least 6 months clinical experience.
NICU-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.
Obstetricians' willingness to perform a caesarean section on maternal request.
One 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).
The 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.
探讨产科医生在无医学指征情况下应产妇要求实施剖宫产的态度。
整群抽样横断面调查。
八个欧洲国家的新生儿重症监护病房（NICU）附属产科单位。
具有至少6个月临床经验的产科医生。
在卢森堡、荷兰和瑞典通过普查选取NICU附属产科单位，在法国、德国、意大利、西班牙和英国通过地理分层随机抽样选取。使用匿名自填式问卷收集数据。
产科医生应产妇要求实施剖宫产的意愿。
105个单位的1530名产科医生参与了研究（回复率分别为70%和77%）。仅仅因为是“她的选择”而遵从假设的女性择期剖宫产要求的比例，在西班牙（15%）、法国（19%）和荷兰（22%）最低；在德国（75%）和英国（79%）最高，其余国家居中。采用加权多因素逻辑回归分析，执业国家（P<0.001）、对诉讼的担忧（P = 0.004）以及在大学附属医院工作（P = 0.001）与医生同意患者要求的可能性相关。有孩子的女医生子集同意的可能性较小（比值比0.29，95%可信区间0.20 - 0.42）。
产科医生态度的差异并非基于具体的医学证据。文化因素、法律责任以及与各国特定围产期护理组织相关的变量发挥了作用。应更加重视理解女性要求择期剖宫产背后的动机、价值观和担忧。
