Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences

Abstract

Background Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women’s preferences for mode of birth and factors underlying preferences for CS. Methods Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual. Results We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women’s partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021. Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth (High confidence), uncertainty regarding vaginal birth (High confidence), and positive views or perceived advantages of CS (High confidence). Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births (High confidence). The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth (High confidence). Conclusions A wide variety of factors underlie women’s preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.

Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives and trainees

“…Some hospitals had insufficient human resources and space limitations impeding constant support during birth. Evidence worldwide suggests fear of pain or lack of pain relief during labour as one of the primary factors underlying women preference for CS 7 15 36 37. Our formative research further reinforces the importance for women to have access to pain management strategies.…”

Flat trend of high caesarean section rates in Peru: A pooled analysis of 3,376,062 births from the national birth registry, 2012 to 2020

“…In this line, mothers and practitioners could prefer a C-section for convenience reasons, and because it is apparently less painful and easier to plan. 26 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 Whether all these C-sections were indeed needed is debatable and deserves further evaluation.…”

Cesarean section in Uruguay from 2008 to 2018: country analysis based on the Robson classification. An observational study

“…However, according to a recent review, only a minority of women from different countries and situations stated a preference for CS as a mode of delivery [ 44 ]. Many studies have even reported that women claimed they lacked autonomy over birth-related decisions, including the experiences of several women who said they had initially rejected the option of a CS, only to be eventually convinced to undergo CS by the doctor in charge at the time [ 45 – 50 ]. In Uruguay, it would be important to review and strengthen the implementation of existing clinical guidelines on the management of induction of labour and scheduling of caesarean delivery.…”