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

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.

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.

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.

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.