Obstetrical provider preferences for cesarean delivery on maternal request in uncomplicated pregnancies: a systematic review of the literature.

OBJECTIVE

This study aimed to review obstetrical providers' personal preferences for cesarean delivery on maternal request in uncomplicated pregnancies.

DATA SOURCES

Searches were performed in Ovid-Medline, Cochrane, Scopus, and CINAHL with terms related to "cesarean," "elective," "scheduled," "maternal request," "physician," "obstetrician," "gynecologist," "midwife," "specialist," and "trainee." There was no limitation placed on the language, year, or location of the studies included in the initial search strategy.

STUDY ELIGIBILITY CRITERIA

Articles were included if they focused on providers' personal preference for cesarean delivery on maternal request, if they were written in or translated into English, and if they did not meet any exclusion criteria.

METHODS

The primary outcome was the percentage of providers preferring cesarean delivery on maternal request in a hypothetical uncomplicated nulliparous term singleton vertex pregnancy. The secondary outcomes included the percentage of providers preferring cesarean delivery on maternal request for a close family member in a nulliparous term singleton vertex pregnancy and the percentage of providers having a personal history of cesarean delivery on maternal request.

RESULTS

Overall, 34 articles were included in the review. The studies were conducted across a range of time and geographic locations. The main providers studied were obstetrician-gynecologists and midwives. In the hypothetical scenario asking their personal delivery preference for a nulliparous term singleton vertex pregnancy, the overall preference rate for cesarean delivery on maternal request among all obstetrical providers was 13.5% (966/7154), specifically 14.3% (894/6250) of obstetrician-gynecologists and 2% (11/574) of midwives; these percentages increased over the last 20 years. In the hypothetical scenario asking their delivery preference for a close family member in a nulliparous term singleton vertex pregnancy, these percentages changed to 28.5% (138/484), 67% (138/206), and 0% (0/278), respectively. The percentage of providers with a personal history of cesarean delivery on maternal request was 20.9% (486/2324) overall, specifically 25.2% (338/1339) of obstetrician-gynecologists and 2% (7/347) of midwives.

CONCLUSION

Overall, 14.3% of obstetrician-gynecologists would prefer cesarean delivery on maternal request for themselves in a hypothetical nulliparous term singleton vertex pregnancy, and this percentage has increased over the last 20 years. Moreover, 25.2% of obstetrician-gynecologists have had cesarean delivery on maternal request themselves, and 67% of obstetrician-gynecologists would recommend it for a close family member. Alternatively, ≤2% of midwives have had or would recommend cesarean delivery on maternal request.