A comprehensive systematic review of factors influencing women's birthing preferences.

Abstract

Although many women prefer a vaginal birth, caesarean deliveries have risen dramatically, reaching more than 50% in some countries, despite a lack of evidence of any increase in obstetric emergencies. Some authors concluded that maternal request is a significant factor in the rising caesarean section rates. There is a need to examine factors that influence women's birthing preferences for normal vaginal birth or caesarean delivery. The objective of this systematic review was to identify factors influencing women's birthing preferences. Studies that involved women with low-obstetric risk, who have given birth at term or were going to give birth.This review considered studies that investigated women's experience of birth and factors influencing women's birth preferences for mode of delivery, excluding preference for place of birth.This review considered studies indicating women's preference for vaginal birth, caesarean section and vaginal birth after caesarean; factors influencing birth preference; and subjective accounts of childbirth during the antenatal period or first postpartum year.This review included quantitative descriptive survey studies and qualitative studies that examined women's childbirth preferences. The search was limited to English language reports from 1990 to 2009. A three step strategy to search for relevant articles was undertaken. Papers selected were assessed by two independent reviewers for methodological validity prior to inclusion in the review using critical appraisal instruments from Joanna Briggs Institute. Quantitative and qualitative data were extracted using standardised data extraction tools from Joanna Briggs Institute. A narrative summary was done for quantitative studies while qualitative findings were pooled into a meta-synthesis. The qualitative meta-synthesis identified three major factors influencing women's birth preferences which were: fear of childbirth that relates to safety, pain, and the rate of recovery of childbirth; sources of information obtained for decision-making, and women's expectations and reality of the birthing body.The quantitative papers reported similar findings including concerns about safety, fear of pain, and previous negative birth experiences. A faster recovery and the wish for a natural childbirth were reasons for women preferring a vaginal birth and vaginal birth after caesarean. Regardless of the mode of birth preferred by women, issues of safety, fear, rate of recovery, expectations of childbirth, and information received from health professionals, were influential factors in these women's decisions. Women's concerns need to be addressed through supportive counselling and health professionals need to provide information regarding childbirth to families in light of their influence on women's decisions. Few studies have reported on long term implications of caesarean section and women's decision making on childbirth choices. Future studies could evaluate the effectiveness of counselling and educational interventions in lowering the rate of caesarean section without medical indications and monitoring the emotional wellbeing of women.