Cesarean delivery on maternal demand: Clinical, ethical, medical and legal aspects [Taglio cesareo su richiesta materna: Aspetti clinici, etici e medico-legali]

Increased rate of cesarean sections has been observed in the last years, and today they correspond to 25-30% of all delivery. Recently, many couples want to decide the route of delivery. Indeed, in 2004, cesarean delivery on demand represented only the 4-18% of all cesarean deliveries and the 14-22% of programmed cesarean sections. This maternal demand derives from social, cultural and medical factors. The FIGO and SOGC guide lines (but not ACOG) claimed cesarean delivery on demand not ethically acceptable. The NCC-WHC and NIH suggest an individual valuation of the cesarean delivery on maternal request after an appropriate and comprehensive counseling. There are some contradictory opinions about cesarean request interesting legal field. The opposite arguments regard the faculty to decide according to science and conscience, the contrast to art. 5 c.c. which forbids the person to dispose own body, the increased mother mortality and morbidity of cesarean section as compared with spontaneous delivery. On the other hand, the self-determination principle of own physical and mental health legitimizes cesarean delivery on request. Therefore, cesarean delivery on maternal request, must be preceded by accurate and exhaustive informed consent