Kalish Robin B, McCullough Laurrence B, Chervenak Frank A
Weill Cornell Medical College, New York, New York 10065, USA.
Curr Opin Obstet Gynecol. 2008 Apr;20(2):116-9. doi: 10.1097/GCO.0b013e3282f55df7.
We have recently identified three salient questions within the patient choice cesarean delivery controversy. First, is performing cesarean delivery on maternal request consistent with good professional medial practice? Second, how should physicians respond to or counsel patients who request patient choice cesarean delivery? Third, should patient choice cesarean delivery be routinely offered to all pregnant women?
In a well informed patient, performing a cesarean delivery on maternal request is medically and ethically acceptable. Physicians, as patient advocates and promoters of overall health and welfare of their patients, however, should, in the absence of an accepted medical indication, recommend against medically unindicated cesarean delivery. While we believe that current evidence supports a physician's decision to accede to an informed patient's request for such a delivery, it does not follow that obstetricians should routinely offer elective cesareans to all patients.
When a patient makes a request for an elective cesarean delivery, obstetricians, in their capacity as patient advocate, must help guide their patient through the labyrinth of detailed medical information toward a decision that respects both the patient's autonomy and the physician's obligation to optimize the health of both the mother and the newborn.
近期我们在产妇要求剖宫产的争议中发现了三个突出问题。其一，应产妇要求实施剖宫产是否符合良好的专业医疗规范？其二，医生应如何回应或为要求产妇要求剖宫产的患者提供咨询？其三，是否应向所有孕妇常规提供产妇要求剖宫产服务？
对于充分知情的患者，应产妇要求实施剖宫产在医学和伦理上是可接受的。然而，医生作为患者的倡导者以及患者整体健康和福祉的促进者，在没有公认的医学指征的情况下，应反对无医学指征的剖宫产。虽然我们认为目前的证据支持医生同意知情患者的此类分娩请求，但这并不意味着产科医生应常规为所有患者提供选择性剖宫产。
当患者要求选择性剖宫产时，产科医生作为患者的倡导者，必须帮助引导患者在详细的医学信息迷宫中做出决策，既要尊重患者的自主权，又要履行医生优化母婴健康的义务。
