Elective Cesarean Section and Decision Making: A Critical Review of the Literature

Authors

  • Chris McCourt BA, PhD,

    Corresponding author
    1. 1Chris McCourt is a Professor, Jane Weaver is a Senior Lecturer, and Sarah Beake is a Research Midwife at the Centre for Research in Midwifery and Childbirth, Thames Valley University, London, United Kingdom; 2Helen Statham is Deputy Director at the Centre for Family Research, University of Cambridge, Cambridge, United Kingdom; and 3Jenny Gamble is a Lecturer and Debra Creedy is a Professor at the Centre for Clinical Practice Innovation, Griffith University, Brisbane, Queensland, Australia.
    Search for more papers by this author
  • 1 Jane Weaver RM, PhD,

    1. 1Chris McCourt is a Professor, Jane Weaver is a Senior Lecturer, and Sarah Beake is a Research Midwife at the Centre for Research in Midwifery and Childbirth, Thames Valley University, London, United Kingdom; 2Helen Statham is Deputy Director at the Centre for Family Research, University of Cambridge, Cambridge, United Kingdom; and 3Jenny Gamble is a Lecturer and Debra Creedy is a Professor at the Centre for Clinical Practice Innovation, Griffith University, Brisbane, Queensland, Australia.
    Search for more papers by this author
  • 1 Helen Statham BSc,

    1. 1Chris McCourt is a Professor, Jane Weaver is a Senior Lecturer, and Sarah Beake is a Research Midwife at the Centre for Research in Midwifery and Childbirth, Thames Valley University, London, United Kingdom; 2Helen Statham is Deputy Director at the Centre for Family Research, University of Cambridge, Cambridge, United Kingdom; and 3Jenny Gamble is a Lecturer and Debra Creedy is a Professor at the Centre for Clinical Practice Innovation, Griffith University, Brisbane, Queensland, Australia.
    Search for more papers by this author
  • 2 Sarah Beake RM, MA,

    1. 1Chris McCourt is a Professor, Jane Weaver is a Senior Lecturer, and Sarah Beake is a Research Midwife at the Centre for Research in Midwifery and Childbirth, Thames Valley University, London, United Kingdom; 2Helen Statham is Deputy Director at the Centre for Family Research, University of Cambridge, Cambridge, United Kingdom; and 3Jenny Gamble is a Lecturer and Debra Creedy is a Professor at the Centre for Clinical Practice Innovation, Griffith University, Brisbane, Queensland, Australia.
    Search for more papers by this author
  • 1 Jenny Gamble PhD,

    1. 1Chris McCourt is a Professor, Jane Weaver is a Senior Lecturer, and Sarah Beake is a Research Midwife at the Centre for Research in Midwifery and Childbirth, Thames Valley University, London, United Kingdom; 2Helen Statham is Deputy Director at the Centre for Family Research, University of Cambridge, Cambridge, United Kingdom; and 3Jenny Gamble is a Lecturer and Debra Creedy is a Professor at the Centre for Clinical Practice Innovation, Griffith University, Brisbane, Queensland, Australia.
    Search for more papers by this author
  • and 3 Debra K. Creedy PhD 3

    1. 1Chris McCourt is a Professor, Jane Weaver is a Senior Lecturer, and Sarah Beake is a Research Midwife at the Centre for Research in Midwifery and Childbirth, Thames Valley University, London, United Kingdom; 2Helen Statham is Deputy Director at the Centre for Family Research, University of Cambridge, Cambridge, United Kingdom; and 3Jenny Gamble is a Lecturer and Debra Creedy is a Professor at the Centre for Clinical Practice Innovation, Griffith University, Brisbane, Queensland, Australia.
    Search for more papers by this author

Chris McCourt, BA, PhD, Centre for Research in Midwifery and Childbirth, Faculty of Health and Human Sciences, Thames Valley University, Westel House, 32-38 Uxbridge Road, London W5 2BS, UK.

Abstract

ABSTRACT: Background: The cesarean section rate continues to rise in many countries with routine access to medical services, yet this increase is not associated with improvement in perinatal mortality or morbidity. A large number of commentaries in the medical literature and media suggest that consumer demand contributes significantly to the continued rise of births by cesarean section internationally. The objective of this article was to critically review the research literature concerning women’s preference or request for elective cesarean section published since that critiqued by Gamble and Creedy in 2000. Methods: A search of key databases using a range of search terms produced over 200 articles, of which 80 were potentially relevant. Of these, 38 were research-based articles and 40 were opinion-based articles. A total of 17 articles fitted the criteria for review. A range of methodologies was used, with varying quality, making meta-analysis of findings inappropriate, and simple summaries of results difficult to produce. Results: The range and quality of studies had increased since 2001, reflecting continuing concern. Women’s preference for cesarean section varied from 0.3 to 14 percent; however, only 3 studies looked directly at this preference in the absence of clinical indications. Women’s preference for a cesarean section related to psychological factors, perceptions of safety, or in some countries, was influenced by cultural or social factors. Conclusions: Research between 2000 and 2005 shows evidence of very small numbers of women requesting a cesarean section. A range of personal and societal reasons, including fear of birth and perceived inequality and inadequacy of care, underpinned these requests. (BIRTH 34:1 March 2007)

Ancillary