OBJECTIVE: to explore obstetricians' opinions on cesarean section (CS) on maternal request in the absence of a medical indication, and the potential to regulate CS on maternal request through financial incentives such as patient co-payment. DESIGN: cross-sectional study. SETTING: Norway. POPULATION/SAMPLE: a total of 507 obstetricians (response rate 71%). METHODS: Questionnaire covering socio-demographic variables, professional experience and attitudes about CS on maternal request (such as willingness to perform, views on how CS on maternal request should be financed). MAIN OUTCOME MEASURES: obstetricians' opinions about CS on maternal request including funding and use of patient co-payments. RESULTS: clinical encounters with CS on maternal request were considered problematic from a clinical viewpoint by 62% of the respondents. While 35% considered the costs of CS on maternal request to be a public responsibility, 40% suggested use of co-payments ranging from euro188- euro7,500. Male obstetricians less frequently considered CS on maternal request problematic and were more likely to favor public funding than females. Female obstetricians favored use of co-payments more often than males (64% female vs. 37% male obstetricians, chi(2) = 23.94, p < 0.001) and suggested higher co-payments. The median co-payment was euro1,875 for female and euro1,250 for male obstetricians (p < 0.001). CONCLUSIONS: the study supports the existence of a gender difference concerning obstetricians' responses to patient requested cesarean section. The results indicate that a substantial proportion of obstetricians welcome some form of constraint concerning cesarean section requests in the absence of a medical indication.
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