{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:43:08Z","timestamp":1788691388731,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2012,11,5]],"date-time":"2012-11-05T00:00:00Z","timestamp":1352073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth"],"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The scientific literature was silent about a relationship of pelvic floor, urinary, and fecal incontinence and sexual issues with mode of birth until 1993, when Sultan et\u00a0al's impressive rectal ultrasound studies were published. They showed that perirectal fibers were damaged in many vaginal births, but not as a result of a cesarean section. These findings helped to pioneer a new area of research, ultimately leading to increasing support among health professionals and the public that maternal choice of cesarean delivery could be justified\u2014even that maternal choice and autonomous decision\u2010making trump other considerations, including evidence. A growing number of birth practitioners are choosing cesarean section for themselves\u2014usually on the basis of concerns over pelvic floor, urinary incontinence, and sexual issues. Behind this choice is a training experience that focuses on the abnormal, interprets the literature through a pathological lens, and lacks sufficient opportunity to see normal childbirth. Cesarean section on maternal request is a complex issue based on fear and misinformation that is a <jats:italic>symptom<\/jats:italic> of a system needing reform, that is, a major change in community and professional education, governmental policy making, and creation of environments emphasizing the normal. Systemic change will require the training of obstetricians mainly as consultants and the education of a much larger cadre of midwives and family physicians who will provide care for most pregnant women in settings designed to facilitate the normal. Tinkering with the system will not work\u2014it requires a complete refit. (<jats:styled-content style=\"fixed-case\">BIRTH<\/jats:styled-content> 39:4 December 2012)<\/jats:p>","DOI":"10.1111\/birt.12006","type":"journal-article","created":{"date-parts":[[2012,11,5]],"date-time":"2012-11-05T23:01:00Z","timestamp":1352156460000},"page":"305-310","source":"Crossref","is-referenced-by-count":19,"title":["Cesarean Section on Maternal Request: A Societal and Professional Failure and Symptom of a Much Larger Problem"],"prefix":"10.1111","volume":"39","author":[{"given":"Michael C.","family":"Klein","sequence":"first","affiliation":[{"name":"Family Practice &amp; Pediatrics University of British Columbia Vancouver  British Columbia Canada"},{"name":"Center for Developmental Neurosciences &amp; Child Health  Child and Family Research Institute Vancouver  British Columbia  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