Flemish obstetricians’ personal preference regarding mode of delivery and attitude towards caesarean section on demand Yves Jacquemyn a,* , Fatima Ahankour a , Guy Martens b a Department of Obstetrics and Gynaecology, Antwerp University Hospital UZA, Wilrijkstraat 10, 2650 Edegem, Belgium b Flemish Study Centre for Perinatal Epidemiology, Brussels, Belgium Received 21 October 2002; received in revised form 31 December 2002; accepted 23 February 2003 Abstract Objectives: To assess Flemish obstetricians’ preferences about mode of delivery for themselves or their partners and to determine the frequency of caesarean section on demand in Flanders. Study design: A structured anonymous postal questionnaire was sent to all 672 registered gynaecologist–obstetricians in Flanders. Results: The response rate was 44%. In the case of an uncomplicated singleton first pregnancy with a cephalic presentation 2% preferred elective caesarean section. There was no difference between male and female obstetricians. Seventy percent said that they would never perform caesarean section on demand. At least 2.6% of all caesarean sections in Flanders seems to be performed on patient’s demand. Conclusion: The attitude of Flemish gynaecologist–obstetricians is clearly in favour of vaginal delivery both for themselves, their partners and their patients. # 2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Flemish obstetricians; Caesarean section; Flanders 1. Introduction World-wide a considerable variation in the caesarean section rate exists, but in general the rate is rising. Obste- tricians’ practice style and personal attitudes towards cae- sarean section are supposed to be important explanatory factors for this variation in the caesarean section rate [1]. We wanted to assess the personal preference of Flemish gynaecologist–obstetricians regarding the mode of delivery for themselves or their partners in an uncomplicated preg- nancy and to determine the frequency of caesarean section on patient request in the Flanders region of Belgium. 2. Materials and methods The names and addresses of 672 gynaecologist–obstetri- cians registered as members of the Flemish Society of Obstetics and Gynaecology (grouping all gynaecologists in Flanders) were obtained. All were sent an anonymous questionnaire in February 2002. The only demographic data registered were sex and age. They were asked if they would theoretically choose for primary elective caesarean section for themselves or their partners in a term uncomplicated singleton pregnancy, without any significant medical or family history, with the baby in a cephalic presentation. In case caesarean section was chosen for, different motiva- tions could be given: minimising perineal damage, mini- mising pain during labour, minimising the risk for long-term sequel such as urinary incontinence, influence on sexual function, minimising fetal risk or any other motivation to be filled in. Further, it was asked how many caesarean sections on demand, without any medical indication, they performed each year. The analysis was performed 2 months after the question- naire was sent. The survey was strictly anonymous, non- responders could not be identified or re-approached. Chi-square test and Fisher’s exact test were used to compare groups, significance was accepted at P < 0:05. Multiple regression was used to construct a model incorpor- ating different factors to determine the amount of caesarean sections on demand. Calculations were performed with SPSS 10.0. 3. Results Of the 672 gynaecologists, 295 replied (44% response rate), all 295 answers were suitable for analysis. There were European Journal of Obstetrics & Gynecology and Reproductive Biology 111 (2003) 164–166 * Corresponding author. Tel.: þ32-3-821-59-45; fax: þ32-3-458-47-74. E-mail address: yves.jacquemyn@uza.be (Y. Jacquemyn). 0301-2115/$ – see front matter # 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0301-2115(03)00214-8