Could a randomised trial answer the controversy relating to elective caesarean section? National survey of consultant obstetricians and heads of midwifery.

International concerns about rising rates of caesarean section are counterbalanced by arguments that planned caesarean section without specific clinical indication (such as breech presentation or HIV infection) falls within legitimate maternal choice. Professional opinion is divided. To perform a caesarean section without clinical reason is seen as ethical, in response to maternal request, by the American College of Obstetricians and Gynecologists; is enshrined in law in Italy; but is viewed as unethical by the International Federation of Gynecology and Obstetrics. The National Institute for Clinical Excellence recommends that a second opinion should be offered. A well designed, randomised controlled trial of planned caesarean section compared with planned vaginal birth could provide important evidence.