Could a randomised trial answer the controversy relating to elective caesarean section? National survey of consultant obstetricians and heads of midwifery

BMJ 2005; 331 doi: (Published 01 September 2005) Cite this as: BMJ 2005;331:490
  1. Tina Lavender, professor of midwifery and women's health (,
  2. Carol Kingdon, research fellow1,
  3. Anna Hart, principal lecturer2,
  4. Gill Gyte, consumer panel coordinator3,
  5. Mark Gabbay, senior lecturer in general practice4,
  6. James P Neilson, professor of obstetrics and gynaecology5
  1. 1 Department of Midwifery Studies, University of Central Lancashire, Preston PR1 2HE
  2. 2 Lancashire School of Health and Post Graduate Medicine, University of Central Lancashire
  3. 3 Cochrane Pregnancy and Childbirth Group, University of Liverpool, Liverpool Women's Hospital, Liverpool L8 7SS
  4. 4 University of Liverpool, Liverpool L69 3GB
  5. 5 School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool Women's Hospital, Liverpool L8 7SS
  1. Correspondence to: T Lavender
  • Accepted 6 July 2005


International concerns about rising rates of caesarean section are counterbalanced by arguments that planned caesarean section without specific clinical indication (such as breech presentation or HIV infection) falls within legitimate maternal choice.1 Professional opinion is divided. To perform a caesarean section without clinical reason is seen as ethical, in response to maternal request, by the American College of Obstetricians and Gynecologists; is enshrined in law in Italy; but is viewed as unethical by the International Federation of Gynecology and Obstetrics. The National Institute for Health and Clinical Excellence recommends that a second opinion should be offered.2 A well designed, randomised controlled trial of planned caesarean section compared with planned vaginal birth could provide important evidence.3

Participants, methods, and results

We aimed to survey all consultant obstetricians and heads of midwifery (gatekeepers to such a trial) practising in England between January 2003 and May 2004. We explored their views of women's requests for caesarean section without clinical indication and of a possible randomised controlled trial …

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