Caesarean sections and ethics

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).