Cesarean section on maternal request: time to respect the choice of the woman

Today, the rate of cesarean sections is increasing worldwide. An underlying important phenomenon is cesarean section on maternal request (cSMR). cSMR is an elective cesarean section without medical and/or obstetric indications. The cSMR rate is often unknown but increasing. Women claim their right to choose how to give birth. Forcing a woman to undergo a vaginal delivery can affect not only her physical well-being but also her psychological well-being, and therefore her health. Over the last 20 years, various countries have developed national and international guidelines for the recognition of the woman's right to choose childbirth, although clear guidelines in this direction have not been established. In Italy, the rate of cSMR is about 9% of all cesarean sections, but it is underestimate. In Italy, cSMR is currently contrary to good care practice, so the doctor has no professional obligations and is entitled to refuse the request for a cesarean section. However, the legislation does not explicitly state that the doctor must refuse such a request. As a result, choice is not available to all the women. In a perspective where women claim their right to health, not only physical but also psychological, the need to develop informed consent for childbirth in general and a guideline on cSMR are unavoidable. This is important both to ensure equal opportunities for all women and to clarify the medical responsibilities and the legal consequences of this choice.