Patient, doctor should discuss delivery options

Ethics Forum. April 7, 2003.

Scenario: Does an obstetrician always have to follow the patient's wishes?

A healthy, 33-year-old pregnant woman tells her obstetrician that she wants to deliver her baby by cesarean section. The patient explains that she wants to be in control of how long the delivery takes and when it is scheduled. She had one prior vaginal delivery without complications but said her sister-in-law told her C-section is safer for the baby. What professional obligations does the obstetrician have toward her patient in discussing this request?

Reply:

I would like to refer to a statement made by Lois Snyder in Ethical Choices (1996, American College of Physicians) as a framework for my assessment of this case. "Determining what is in the patient's best interest is a matter of professional judgment and medical indication, not a function of patient pressure. The welfare of the patient is paramount in the consultative process. Being a patient advocate does not necessarily mean doing everything the patient wants."

The latest edition of Williams Obstetrics lists accepted indications for cesarean section as: previous cesarean delivery, fetal malpresentation such as breech or transverse lie, fetal distress in labor, active genital herpes simplex and dystocia. Most practitioners would add to the short list of indications a previous surgical repair for pelvic floor defects and a history of sexual abuse/posttraumatic stress disorder with sexual aversion.