Influence of women's request and preference on the rising rate of caesarean section – a comparison of reviews

Panda, Sunita; Begley, Cecily; Daly, Déirdre

doi:10.1016/j.midw.2020.102765

Cited by 15 publications

(15 citation statements)

References 34 publications

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“…There is a need to assess to what extent the fear of pain and injuries are women related factors, or whether they are the result of providers’ messages intended to perform CS with the purpose of rushing births. These findings are consistent with other studies where women felt they didn’t establish balanced power relations with their healthcare providers [ 79 – 81 ], and where they described themselves as ‘agreeing’ with and ‘going with the flow’ of professionals’ recommendations [ 82 ]. Under these circumstances it is not salient that women placed themselves under the control of their doctors as a way to feel safe, convinced that technocratic knowledge and technological advances in CS were associated with the idea of safer birth outcomes.…”

Section: Discussionsupporting

confidence: 91%

“…Under these circumstances it is not salient that women placed themselves under the control of their doctors as a way to feel safe, convinced that technocratic knowledge and technological advances in CS were associated with the idea of safer birth outcomes. Also, the technical language use to present information to a woman might steer the woman’s decision to choose her mode of birth [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

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

Colomar¹,

Opiyo

Kingdon

et al. 2021

PLoS ONE

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

Colomar¹,

Opiyo

Kingdon

et al. 2021

PLoS ONE

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“…Although ‘ shared decision-making ’ in maternity care is gaining emphasis in the recent times, there are barriers in ‘ communication ’ and the ‘ discourse ’ in the process of decision-making [ 15 ]. Clinicians’ communication with women and the way information is presented play a vital role in the process of decision-making, and women’s involvement in the process [ 52 ]. Use of a specialised language in ‘ institutional discourse’ is described as a form of abstraction that removes one from the reality behind the words [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…Use of a specialised language in ‘ institutional discourse’ is described as a form of abstraction that removes one from the reality behind the words [ 53 ]. For example, common phrases in clinical practice such as, ‘ failure to progress ’, ‘ fetal distress ’, ‘ cephalopelvic disproportion ’, ‘ lack of growth ’, ‘failed induction of labour’ overlook what is ‘ real ’, and drive women to ‘ agree ’ to and ‘ go with the flow ’ of professionals’ recommendations [ 52 ]. With regards to CS on maternal request, while a few midwives in the study believed that all clinicians had a professional duty to ensure that women were aware of the consequences of having a CS, a few obstetricians viewed CS by maternal request as a ‘legitimate choice’ especially with advances in anaesthesia and low morbidity and mortality related to elective CS.…”

Section: Discussionmentioning

confidence: 99%

Clinicians’ views of factors influencing decision-making for CS for first-time mothers—A qualitative descriptive study

2022

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Clinicians’ perspectives of the reasons for performing caesarean section (CS) are fundamental to deepening knowledge and understanding of factors influencing decision-making for CS. The aim of this study was to explore midwives’ and obstetricians’ views of factors influencing decision-making for CS for first-time mothers. A qualitative descriptive study with semi-structured one-to-one audio-recorded interviews was used to gather data from clinicians (15 midwives and 20 senior obstetricians). Following research ethics committee approval, clinicians, who were directly involved in the decision-making process for CS during the period of data collection, were purposively selected from three maternity units in the Republic of Ireland between June 2016 to July 2017. The interviews were transcribed verbatim and analysed thematically. Three interrelated themes with several subthemes reflective of clinicians’ views and experiences emerged following data analysis. These were: ‘A fear factor’ describing clinicians’ fear of adverse outcomes and subsequent litigation, ‘Personal preferences versus a threshold–clinician driven factors emphasising the influence of clinicians’ personal beliefs, and ‘Standardised versus individualised care–a system perspective’ explaining the effects of, or lack of, organisational policy and its direct and indirect impact on the decision-making process. Findings show that decisions to perform a CS are, on occasion, based on clinicians’ personal beliefs and interpretation, similar to findings from other published literature. Consideration of broader issues related to organisational, socio-cultural and political context is essential when seeking solutions to the rising CS rates. The findings will enable clinicians to reflect on their day-to-day practice, in order to look for modifiable factors that influence their decision-making, and help women understand the multitude of factors that can lead to a decision to perform a CS. Findings will also contribute to the development of the ‘next step action’ and assist in devising future intervention studies to reduce any unnecessary CSs.

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“…However, a significant proportion of healthy women undergo CS unnecessarily despite the increased risk of serious maternal outcomes with the procedure, and counter to the recommendation to perform it only when the benefits anticipated are clear and offset the increased cost and additional risk associated with the operation [ 5 ]. Multiple factors account for that increase [ 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

Colomar¹,

Colistro

Sosa

et al. 2022

BMC Pregnancy Childbirth

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Background The use of caesarean section has steadily increased, with Latin America being the region with the highest rates. Multiple factors account for that increase and the Robson classification is appropriate to compare determinants at the clinical level for caesarean section rates over time. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database. Methods We included the records of all women giving birth in Uruguay (pregnancies ≥22 weeks and weights ≥500 g) with valid data in the mode of childbirth recorded in the Perinatal Information System database between 2008 and 2018. Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital), with time trends and their significance analyzed using linear regression models. Results Of the total 485,263 births included in this research, the overall caesarean section rate was 43,1%. In 2018, among the groups at lower risk of caesarean section (1 to 4), the highest rates were seen in women in group 2B (98,8%), followed by those in group 4B (97,9%). A significant increase in the number of caesarean sections was seen in groups 2B (97,9 to 98,8%), 3 (8,36 to 11,1%) and 4 (A (22,7 to 26,9%) and B (95,4 to 97,9%) Significant growth was also observed in groups 5 (74,3 to 78,1%), 8 (90,6 to 95,5%), and 10 (39,1 to 46,7%). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section (1, 2A, 3 and 4A), followed by the private sector outside of the capital. Conclusion Uruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted.

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Influence of women's request and preference on the rising rate of caesarean section – a comparison of reviews

Cited by 15 publications

References 34 publications

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

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

Clinicians’ views of factors influencing decision-making for CS for first-time mothers—A qualitative descriptive study

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

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