Influence of women's request and preference on the rising rate of caesarean section – a comparison of reviews. (September 2020)

• Record Type: Journal Article
• Authors: Panda, Sunita; Begley, Cecily; Daly, Deirdre
• Is Part Of: Midwifery. Volume 88(2020)
• Publication Date: 2020-09
• Subjects: Caesarean section -- Women -- Decision-making -- Midwives -- Obstetricians -- Systematic review; Midwifery -- Periodicals; Midwifery -- Periodicals; Sages-femmes -- Périodiques; Midwifery; Periodicals; Electronic journals; 618.2005
• DOI: 10.1016/j.midw.2020.102765
• Languages: English
• ISSNs: 0266-6138

Abstract

Highlights: In some studies 'women's request' is cited as a key factor contributing to the decision to perform a CS while other literature states that it has minimal influence. A recent systematic review and metasysthesis found that clinicians viewed women's request as a key factor influencing their decision to perform a CS, but three previous reviews found that women's request had a minimal contribution on the overall rising rates of CS. Communication between women and their clinicians, clinicians' beliefs and their interpretation of 'women's concerns' as their 'request or preference for CS', and use of an institutional discourse of 'safe/unsafe', may lead women to 'agree' with the clinician's recommendation. Abstract: The rising caesarean section (CS) rates have been, in part, attributed to women's requests. Several individual studies and literature reviews have attempted to determine the degree of influence of women's requests on overall CS rates, and the common reasons behind these requests, from women's, midwives' and obstetricians' viewpoints. Despite many similarities in their findings, there is both a lack of clarity and disparity on the degree of influence women's requests actually has on the decision to perform a CS. This paper presents a critique of a key finding from a recently published systematic review of clinicians' (midwives' and obstetricians') views of factors that influenced their decision to perform a CS, which identified their belief in 'women's request' as a key factor. This finding is contrasted with findings from three other published reviews, which concluded that women's request contributed minimally to the overall rising rates of CS indicating a disparity in evidence around influence and contribution of women's request. Some of the possible reasons for this disparity can be explained by differences in views of women and clinicians, women's decision being guided by clinicians' beliefs of what is 'safe' and unsafe', and women's concerns being interpreted as their request and preferences to birth by CS. An insight into the possible reasons for the disparity in findings can help explain whether maternal request has any influence on the rising rates of CSs.