At a time when there is much criticism of increasing caesarean section rates, as well as an increased emphasis on involving the patient in decisions regarding her care, we decided to assess the effect of maternal request on the elective caesarean section rate. The study was a prospective patient interview and case note review, set at a District General Hospital in Watford, Hertfordshire over a 1-year period. Eligible patients included all women undergoing elective caesarean section, with the main outcome measure being the number of elective caesarean sections performed without obstetric contraindication to vaginal delivery. Out of 3025 deliveries, 570 (18.8%) were delivered by caesarean section, 276 (9.1%) electively and 293 (9.7%) as an emergency procedure. Of the elective procedures (18.2% of the total number of operations), 38% were performed because of maternal request. We conclude that maternal request is a significant factor in the rise in caesarean section rate.