What are women’s mode of birth preferences and why? A systematic scoping review

Abstract

Background:The optimal caesarean section rate is estimated to be between 10-15%; however, it is much higher in high and many middle-income countries and continues to be lower in some middle and low-income countries. While a range of factors influence caesarean section rates, women's mode of birth preferences also play a role. The aim of this study was to map the literature in relation to women's mode of birth preferences, and identify underlying reasons for, and factors associated with, these preferences.Method: Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined.Findings: A total of 65 studies were included. While the majority of women prefer a vaginal birth, between 5-20% in high-income countries and 1.4 to 50% in low-middle-income countries prefer a caesarean section. The six main reasons or factors associated with a mode of birth preference were: 1) perceptions of safety; 2) fear of pain; 3) previous birth experience; 4) encouragement and dissuasion from health professionals; 5) social and cultural influences; and 6) access to information and educational levels. Conclusion:2 To help ensure women receive the required care that is aligned with their preferences, processes of shared decision-making should be implemented. Shared decision-making has the potential to reduce the rate of unnecessary interventions, and also improve the willingness of women to accept a medically-indicated caesarean section in low-income countries.

Why do pregnant women prefer cesarean birth? : a qualitative study in a tertiary care center in Southern Thailand

“…Almost all aspects were in accordance with previous studies [10][11][12][13]15], except for the personal superstitious belief in auspicious birth dates, which has been found only in some Asian countries (such as China, India, Taiwan and Thailand). Having broids removed during a cesarean section as an advantage of having a cesarean delivery was mentioned by some participants, this however was a misunderstanding, because this procedure may cause profound or uncontrolled hemorrhage, which may lead to hysterectomy.…”

“…In this study, fear of childbirth was the most common reason for cesarean birth preference, which was similar to previous studies [10][11][12][13]15,16]. Obstetricians should explore why women fear because fear of pain cannot be managed by cesarean section, which by itself will lead to pain afterwards.…”

“…Due to this issue, obstetricians should clarify any misunderstandings and the exact risks and bene ts in regards to modes of birth, as there are some serious consequences of cesarean delivery; especially placental adherence in future pregnancies. Safety concerns based on health risk perception has also been mentioned in previous studies [10,13].…”

“…Previous qualitative studies in other countries have found that factors associated with cesarean preference were fear of pain, previous cesarean birth, previous negative birth experiences, multiparity, socioeconomic status and maternal age [10][11][12]. A recent systematic review of 65 studies indicated six main reasons related to mode of birth preference: 1) maternal perception of safety; 2) fear of pain; 3) previous birth experiences; 4) encouragement and dissuasion from health professionals; 5) social and cultural in uences; and 6) access to information and educational levels [13]. It is of interest to explore reasons why some women preferred cesarean birth.…”

Caesarean section births for twins: rational choice, or a non‐evidence‐based intervention that may cause harm?

“…It is curious that the results of the Term Breech Trial changed practice almost overnight, but those of the analogous study of twin pregnancies (by the same researchers) have been largely disregarded. Shared decision‐making about the mode of birth may limit the use of caesarean birth, and should be based on evidence rather than opinion …”