Elective cesarean section and decision making: A critical review of the literature

Chris McCourt, Jane Weaver, Helen Statham, Sarah Beake, Jenny Gamble, Debra K. Creedy

Research output: Contribution to journalReview articlepeer-review

223 Citations (Scopus)

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).

Original languageEnglish
Pages (from-to)65-79
Number of pages15
JournalBirth
Volume34
Issue number1
Early online date26 Feb 2007
DOIs
Publication statusPublished - Mar 2007
Externally publishedYes

Keywords

  • cesarean section
  • decision making
  • choice
  • childbirth

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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