Furthermore, in 2003, an ACOG ethics committee stated that it is ethical for doctors to
perform elective caesarean sections on pregnant women who face no known risks from vaginal delivery.
Because
elective Caesareans occurred only in the «intended a hospital birth» group, their inclusion in this analysis would have artificially inflated the risk of PPH for hospital births, because
elective Caesareans tend to be
performed in response to fears about the safety of vaginal delivery, eg if the foetus is malpresented.