Women’s preference for caesarean section: a systematic review and meta-analysis of observational studies
Article first published online: 7 DEC 2010
© 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 118, Issue 4, pages 391–399, March 2011
How to Cite
Mazzoni, A., Althabe, F., Liu, N., Bonotti, A., Gibbons, L., Sánchez, A. and Belizán, J. (2011), Women’s preference for caesarean section: a systematic review and meta-analysis of observational studies. BJOG: An International Journal of Obstetrics & Gynaecology, 118: 391–399. doi: 10.1111/j.1471-0528.2010.02793.x
- Issue published online: 10 FEB 2011
- Article first published online: 7 DEC 2010
- Accepted 11 October 2010. Published Online 7 December 2010.
- Caesarean section;
Please cite this paper as: Mazzoni A, Althabe F, Liu N, Bonotti A, Gibbons L, Sánchez A, Belizán J. Women’s preference for caesarean section: a systematic review and meta-analysis of observational studies. BJOG 2011;118:391–399.
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 Thirty-eight 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 24.4–34.8 versus 10.1%; 95% CI 7.5–13.1), and those living in a middle-income country versus a high-income country (22.1%; 95% CI 17.6–26.9 versus 11.8%; 95% CI 8.9–15.1).
Authors’ 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.