Background The striking increase in caesarean section rates in middle and high-income countries has been partly attributed to maternal request. We conducted a systematic review and meta-analysis of women’s preferences for caesarean section. Objectives To review the published literature on women’s preferences for caesarean section. Search strategy A systematic search of MEDLINE, EMBASE, LILACS and PsychINFO was performed. References of all included articles were examined. Selection criteria We included studies that quantitatively evaluated women’s preferences for caesarean section in any country. We excluded articles assessing health providers’ preferences and qualitative studies. Data collection and analysis Two reviewers independently screened abstracts of all identified citations, selected potentially eligible studies, and assessed their full-text versions. We conducted a meta-analysis of proportions, and a meta-regression analysis to determine variables significantly associated with caesarean section preference. Main Results 38 studies were included (n= 19,403). The overall pooled preference for caesarean section was 15.6% (95% CI: 12.5–18.9). Higher preference for caesarean section was reported in women with a previous caesarean section versus women without a previous caesarean section (29.4% – 95% CI: 24.4 to 34.8 - versus 10.1% – 95% CI: 7.5 to 13.1), and those living in a middle-income country versus a high-income country (22.1% –95% CI: 17.6 to 26.9 -versus 11.8% – 95% CI: 8.9 to 15.1). Conclusions Only a minority of women in a wide variety of countries expressed a preference for caesarean delivery. Further research is needed to better estimate the contribution of women’s demand to the rising caesarean section rates.

Objective To assess the risk of adverse perinatal events of vaccination of pregnant women with an MF59 adjuvanted vaccine.Design Cross sectional multicentre study. Main outcome measure Primary composite outcome of low birth weight, preterm delivery, or fetal or early neonatal death up to seven days postpartum.Results Vaccinated women had a lower risk of the primary composite outcome (7.0% (n=513) v 9.3% (n=2160); adjusted odds ratio 0.80, 95% confidence interval 0.72 to 0.89). The propensity score analysis showed similar results. Adjusted odds ratios for vaccinated women were 0.74 (0.65 to 0.83) for low birth weight, 0.79 (0.69 to 0.90) for preterm delivery, and 0.68 (0.42 to 1.06) for perinatal mortality. These findings were consistent in further subgroup analysis. No significant differences in maternal outcomes were found. ConclusionThis large study using primary data collection found that MF59 adjuvanted A/H1N1 influenza vaccine did not result in an increased risk of adverse perinatal events and suggested a lower risk among vaccinated women. These findings should contribute to inform stakeholders and decision makers on the prescription of vaccination against influenza A/H1N1 in pregnant women.

BackgroundRates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women’s preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors.MethodsA prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women’s preferences: a survey using a tailored questionnaire, and a discrete choice experiment.ResultsOnly 8 and 6 % of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40 % ended their pregnancies by caesarean section in public and private hospitals, respectively.ConclusionsThe preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35 % caesarean sections are unlikely related to their preferences for mode of delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0824-0) contains supplementary material, which is available to authorized users.

Community-based supplementary feeding for promoting the growth of children under five years of age in low and middle income countries.

There were few clinically significant differences in medical care between Argentine women and resident immigrant women during the prepartum and intrapartum periods.