Caesarean Delivery on Maternal Request: A New Zealand Perspective

Abstract

In many countries, including New Zealand, the caesarean delivery rate far exceeds the current WHO recommendation of 10-15% of live births. This is causing concern amongst a number of parties. One of the explanations for the rate increasing so quickly and to such an extent is Caesarean Delivery on Maternal Request (CDMR).

There have been no studies conducted on CDMR in a New Zealand context to date. This qualitative study explored the perceptions of a group of New Zealand obstetricians’ and midwives’ on CDMR. The information was obtained via 12 face-to-face semi-structured interviews. The maternity providers were asked if they had ever encountered requests, whether they believed that it was ever reasonable to accede to a request for a caesarean section in a low-risk pregnancy, and whether there was a place for these procedures in the public healthcare system. An ethical analysis followed thematic analysis of the data. The ethical justification for the interviewee’s responses was analysed in the light of the four principles of biomedical ethics as articulated by Beauchamp and Childress; autonomy, beneficence, non-maleficence and justice.

The results of this study show that there is no standardized approach to CDMR in New Zealand, raising concerns about equity of access. For this reason the development and implementation of a national care pathway for CDMR is commendable.