[Change in indications for cesarean section].

The drastic decrease in the maternal lethality risk has influenced the indication for caesarean section. As the overall difference in mortality and morbidity between elective caesarean section and attempted vaginal delivery decreases, the consequence is a more liberal indication for caesarean section in order to avoid pain, damage to the pelvic structures and to protect the fetus. Maternal autonomy has to be respected by the obstetrician. He must know on what premises the mother has to be informed and given sufficient time to make a decision in favour of or against a caesarean section. To enable the patient to take the best decision, it is essential that she has ready access to reliable evidence-based information of the maternal and fetal risks. The motives of a woman asking for an elective caesarean section must be included into the medical indication. But even without a medical indication, respecting the right of self-determination of the woman, caesarean section on demand is in principle permitted by German law, since it is generally accepted that patients are entitled to request operations, which are not medically necessary, such as sterilisation, abortion and cosmetic surgery. When there is no contra-indication, the obstetrician can comply with the serious request of the woman, but without being obliged to do so.The drastic decrease in the maternal lethality risk has influenced the indication for caesarean section. As the overall difference in mortality and morbidity between elective caesarean section and attempted vaginal delivery decreases, the consequence is a more liberal indication for caesarean section in order to avoid pain, damage to the pelvic structures and to protect the fetus. Maternal autonomy has to be respected by the obstetrician. He must know on what premises the mother has to be informed and given sufficient time to make a decision in favour of or against a caesarean section. To enable the patient to take the best decision, it is essential that she has ready access to reliable evidence-based information of the maternal and fetal risks. The motives of a woman asking for an elective caesarean section must be included into the medical indication. But even without a medical indication, respecting the right of self-determination of the woman, caesarean section on demand is in principle permitted by German law, since it is generally accepted that patients are entitled to request operations, which are not medically necessary, such as sterilisation, abortion and cosmetic surgery. When there is no contra-indication, the obstetrician can comply with the serious request of the woman, but without being obliged to do so.