Abstract: Background: The issue about whether a woman's autonomy in childbirth should include the choice of cesarean delivery in the absence of medical indications has become a major source of debate. Our objective was to examine factors that determined physicians’ responses to patient-requested cesarean delivery. Methods: Surveys were distributed to all obstetrician-gynecologists in the greater Portland, Oregon, metropolitan area in Spring, 2000. Physicians were asked to respond to scenarios involving a term patient with a singleton pregnancy requesting primary cesarean delivery. Results: One hundred and seventy of 255 physicians (67%) responded, of whom 68 to 98 percent agreed to cesarean delivery in cases with clear medical indications. Without a clear medical indication, most practitioners would not perform a cesarean delivery. In cases where medical indications were unclear, responses were divided. Physician male gender and patient high socioeconomic status were associated with increased likelihood of physician agreement to patient-requested cesarean delivery. Age, years in practice, and practice type were not associated with agreement. Conclusions: Physicians are reluctant to agree to patient request for primary cesarean delivery without a clear medical indication. Male physicians were more likely to agree to a patient's request for cesarean delivery than female physicians.