Attitudes of Midwives in Sweden Toward a Woman’s Refusal of an Emergency Cesarean Section or a Cesarean Section on Request

Authors

  • Margaretha Danerek PhD, RN, RM,

    1. Margaretha Danerek is a Senior Lecturer in the Department of Health Sciences, Faculty of Medicine, University Lund, Lund; Karel Maršál is a Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden; Marina Cuttini is a Professor in the Unit of Epidemiology, Ospedale Pediatricio Bambino Gesù, Rome, Italy; Göran Lingman is an Associate Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund; Tore Nilstun is a Professor in the Department of Medical Ethics, Clinical Sciences, Lund University, Lund; and Anna-Karin Dykes is an Associate Professor in the Department of Health Sciences, Faculty of Medicine, Lund University, Lund and Visiting Professor at Department of Health and Society, Malmö University, Sweden.
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  • Karel Maršál MD,

    1. Margaretha Danerek is a Senior Lecturer in the Department of Health Sciences, Faculty of Medicine, University Lund, Lund; Karel Maršál is a Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden; Marina Cuttini is a Professor in the Unit of Epidemiology, Ospedale Pediatricio Bambino Gesù, Rome, Italy; Göran Lingman is an Associate Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund; Tore Nilstun is a Professor in the Department of Medical Ethics, Clinical Sciences, Lund University, Lund; and Anna-Karin Dykes is an Associate Professor in the Department of Health Sciences, Faculty of Medicine, Lund University, Lund and Visiting Professor at Department of Health and Society, Malmö University, Sweden.
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  • Marina Cuttini MD,

    1. Margaretha Danerek is a Senior Lecturer in the Department of Health Sciences, Faculty of Medicine, University Lund, Lund; Karel Maršál is a Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden; Marina Cuttini is a Professor in the Unit of Epidemiology, Ospedale Pediatricio Bambino Gesù, Rome, Italy; Göran Lingman is an Associate Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund; Tore Nilstun is a Professor in the Department of Medical Ethics, Clinical Sciences, Lund University, Lund; and Anna-Karin Dykes is an Associate Professor in the Department of Health Sciences, Faculty of Medicine, Lund University, Lund and Visiting Professor at Department of Health and Society, Malmö University, Sweden.
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  • Göran Lingman MD,

    1. Margaretha Danerek is a Senior Lecturer in the Department of Health Sciences, Faculty of Medicine, University Lund, Lund; Karel Maršál is a Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden; Marina Cuttini is a Professor in the Unit of Epidemiology, Ospedale Pediatricio Bambino Gesù, Rome, Italy; Göran Lingman is an Associate Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund; Tore Nilstun is a Professor in the Department of Medical Ethics, Clinical Sciences, Lund University, Lund; and Anna-Karin Dykes is an Associate Professor in the Department of Health Sciences, Faculty of Medicine, Lund University, Lund and Visiting Professor at Department of Health and Society, Malmö University, Sweden.
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  • Tore Nilstun PhD,

    1. Margaretha Danerek is a Senior Lecturer in the Department of Health Sciences, Faculty of Medicine, University Lund, Lund; Karel Maršál is a Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden; Marina Cuttini is a Professor in the Unit of Epidemiology, Ospedale Pediatricio Bambino Gesù, Rome, Italy; Göran Lingman is an Associate Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund; Tore Nilstun is a Professor in the Department of Medical Ethics, Clinical Sciences, Lund University, Lund; and Anna-Karin Dykes is an Associate Professor in the Department of Health Sciences, Faculty of Medicine, Lund University, Lund and Visiting Professor at Department of Health and Society, Malmö University, Sweden.
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  • Anna-Karin Dykes PhD, RN, RM

    1. Margaretha Danerek is a Senior Lecturer in the Department of Health Sciences, Faculty of Medicine, University Lund, Lund; Karel Maršál is a Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden; Marina Cuttini is a Professor in the Unit of Epidemiology, Ospedale Pediatricio Bambino Gesù, Rome, Italy; Göran Lingman is an Associate Professor in the Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund; Tore Nilstun is a Professor in the Department of Medical Ethics, Clinical Sciences, Lund University, Lund; and Anna-Karin Dykes is an Associate Professor in the Department of Health Sciences, Faculty of Medicine, Lund University, Lund and Visiting Professor at Department of Health and Society, Malmö University, Sweden.
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Address correspondence to Margaretha Danerek, PhD, RN, RM, Department of Health Sciences, Faculty of Medicine, University Lund Box 157, 221 00 Lund, Sweden.

Abstract:

Background:  A woman’s refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician’s decision making in relation to a woman’s refusal of an emergency cesarean section and to a woman’s request for a cesarean section without a medical indication.

Methods:  The study has a cross-sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259).

Results:  In the case of a woman’s refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman’s request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman’s decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman’s autonomy in this situation. If the only reason was “her own choice,” 77 percent of the midwives responded that the obstetrician should not comply.

Conclusions:  The main focus of midwives seems to be the baby’s health, and therefore they do not always agree with respect to a woman’s refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician. (BIRTH 38:1 March 2011)

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