I don't think a patient can "refuse" a vaginal delivery, meaning that you cannot be forced to perform a surgery, i.e. cesarean section, especially if you do not believe it is medically necessary. Actually, I don't think you can be forced to perform any procedure, but you have to provide the patient with other options, doctors etc. That means that you can, properly and legitimately turf the patient to another OB who may be willing to do an elective c/s if you are not. You'd have to document appropriately, give a reasonable time for them to find another OB, etc. But you cannot be forced to perform a c/s just because a patient didn't want a vaginal delivery.
That being said, I would hope that if a patient felt that strongly about not having a vaginal delivery, you would have had a discussion with her way before she is term and the issue is immediately at hand.
As for insurance... that's a good question. I have no idea. I do know that most pregnancies and deliveries are reimbursed under a set rate that includes all prenatal visits, the delivery itself and the postpartum visit. I'm not sure how a completely elective section falls in regards to reimbursement.
Trillgirl
(now Chief Resident Trillgirl -arrrrggghhhh!)
