Author(s): Minkoff HL, Berkowitz R
Each year tens of thousands of pregnancies are conceived through assisted reproductive technologies, and increasing numbers of pregnant women are aged older than 40 years. The obstetric management of these pregnancies, including more liberal recourse to cesarean delivery, has at times reflected the belief of providers that they are dealing with "precious babies". A leitmotif in discussions of the "precious child" is the concept that precious equates to irreplaceable (ie, mother who has tried harder to conceive may well have less chance to succeed again in the future). We believe that the obstetrician who decides to modify obstetric care because of these factors is, in fact, substituting physician assumption for patient autonomy. Although it is not counterintuitive to believe that a woman who has gone through assisted reproductive technologies would willingly (perhaps even eagerly) undergo cesarean delivery to avoid even remote risks, it is not safe to assume that women who conceived naturally would not. It is our contention that ultimately all women are best served if every pregnancy were treated as although it had preeminent value.