Physicians' Gender and Patients' Socioeconomic Status Affect Decision To Perform C-Sections

12/09/04    Portland, Ore.

Male physicians were significantly more likely than female physicians to agree to perform a Caesarean section, at the patient's request when not medically necessary, according to a recent study conducted by OHSU researchers published in the journal Birth. While there were no differences between male and female physician responses when Caesarean was clearly indicated or when medical indications for a C-section were unclear, male physicians were 1.8 to 5 times more likely to agree to a patient-requested Caesarean in the absence of medical indications. The difference between male and female physicians agreeing to a Caesarean was 29 percent versus 9 percent for women expressing concerns for future urinary incontinence; and 24 percent versus 4.5 percent for a woman reporting a history of prior stillbirth.

It also was found that a patient's higher socioeconomic status increased the likelihood of the male physician's agreement to a patient requested C-section.

This study is the first in 18 years to examine responses of physicians in the United States to patient-requested Caesareans.

"This study is important because the debate about a woman's choice to have a Caesarean is rapidly growing. Many physicians are facing increasing numbers of requests in their own practices. It is important to identify factors that influence decision making. Further studies are needed to better understand reasons for the differences in responses between genders, to further understand which specific patient factors play a role in the decision making, and how patient and physician attitudes will change as attention to this topic increases," said Jeanne-Marie Guise, M.D., M.P.H., associate professor of obstetrics and gynecology, medical informatics and clinical epidemiology, public health and preventive medicine, OHSU School of Medicine, and the study's senior author.

Benjamin K.S. Chan, M.S., senior research associate in endocrinology, diabetes and clinical nutrition, and Chiara Ghetti, M.D., former instructor, obstetrics and gynecology, OHSU School of Medicine and currently an assistant professor of urogynecology, at Magee-Women's Hospital of the University of Pittsburgh Medical Center, also were authors on this study.

Questionnaires, consisting of 17 clinical scenarios, were sent to 255 obstetrician-gynecologists in the American Medical Association directory in metropolitan Portland. One hundred seventy, or 67 percent, responded. The research was supported by a grant from the Agency of Healthcare Research and Quality of the U.S. Department of Health and Human Services.