Obstetric professionals' perceptions of cesarean delivery upon maternal request in Bergen, Norway

Background: Cesarean delivery rates are increasing worldwide, despite potential evidence of increased medical risk when the procedure is not medically indicated and the negative economic consequences of overtreatment. Greater personal wealth, advanced fetal monitoring, and physician fear of litigation are some of the causes cited for increasing cesarean rates. Cesarean upon maternal request (CDMR) is an additional component - one that is often cited by obstetric professionals, but the rate of occurrence is largely unknown. CDMR requires obstetricians to balance ethical concepts of patient autonomy and beneficence, as well as the implications of increasing hospital and national rates. This project aimed to generate additional information about the experience of obstetric professionals regarding CDMR to supplement the largely normative ethical arguments found in existing literature. Objectives: To explore obstetric professionals' perceptions of CDMR in Bergen, Norway. Methods: Eight practicing obstetric professionals in Bergen, Norway were interviewed. The findings were analyzed using thematic analysis. Results: Resulting analysis found that a confident, self- defined professional identity and a protective workplace culture supported the clinical decision-making process. Additionally, a compassionate perception of women requesting cesarean section and confidence in a normalized birth experience directed patient communication, with the idealized outcome of an empowered, vaginal birth. Informants illustrated a relational understanding of autonomy that attempted to both respect the patients' wishes while maintaining their professional integrity