• Caesarean section;
  • childbirth;
  • choice;
  • delivery;
  • obstetric;
  • prefer;
  • request

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.