Health Professionals' Attitudes to Maternal Request for Caesarean Birth: A Scoping Review

Caesarean birth rates are rising worldwide, and projections show that by 2030, 28.5% of women worldwide (or 38 million) will give birth by caesarean delivery. The World Health Organization (WHO) has urged health professionals to limit caesarean births to those supported by medical evidence, with guidelines including the recommendations that all women be involved in their birthing decisions and for the caesarean birth (CB) rate not to exceed 10%-15%. However, it has been suggested that adhering to these rates may be detrimental to women and babies. The proportion of Maternal Request for Caesarean Birth (MRCB) varies significantly across the globe (0.2%-42%) averaging 3% of the five million caesarean births reported in a 2018 global review. The aim of this scoping review is to explore the breadth of the literature on health professionals' attitudes towards MRCB, to summarise the evidence and identify gaps in the current knowledge base, with a view to informing future research.

The scoping review was conducted according to the Joanna Briggs Institute (JBI) methodology for scoping reviews. Four databases-CINAHL, Medline, PsycInfo and Web of Science were searched from inception to 31 October 2024. A total of 48 quantitative, qualitative, and mixed methods studies were included. Data were charted to a template which included the categories: cohort, gender, methodology, rationale in practice, rationale for personal choice and key findings.

Findings showed that the rates of health professionals willing to perform MRCB varied considerably between countries and rationale for performing them was multifactorial, encompassing both ethical and legal considerations. Rates for HPs choosing CB for themselves, or their partners were higher than the estimated global MRCB rates, and rationale for choice differed significantly from their rationale for performing a MRCB on their patients. The findings in relation to the attitudes of midwives towards MRCB were significant as they did not recognise tocophobia as a rationale for choosing MRCB and their counselling was aimed towards changing a woman's mind as opposed to respecting maternal autonomy.

Precise and contemporaneous global reporting of MRCB rates is recommended, in conjunction with the implementation of specific MRCB guidelines and consent. Counselling education for health professionals could facilitate doctor-patient shared decision-making. Further research on non-medical interventions and their efficacy could address concerns in the global escalation of MRCB rates.