Systematic review and meta-analysis of studies on delivery preferences in Brazil.

Abstract

Cesarean delivery rates in Brazil are among the highest in the world. User preference is often mentioned as an important factor driving this. To identify, appraise, and synthesize the results of studies into delivery preferences in Brazil. MEDLINE, LILACS, and PsycINFO databases were searched, without language restrictions, using "delivery" and "preference" from inception to November 4, 2017. Cross-sectional or cohort studies with quantitative data on delivery preferences of lay persons in Brazil. Two reviewers performed study selection, quality assessment, and data extraction. A meta-analysis of proportions with a preference for cesarean delivery was performed, including subgroups analyses. There were 28 studies with 31071 participants included. The overall prevalence of preference for cesarean delivery was 27.2% (95% confidence interval [CI] 26.7%-27.7%; 28 studies, n=31071). Cesarean delivery preference was higher among multiparas with previous cesarean deliveries (58.0%, 95% CI 56.6%-59.3%; nine studies, n=5542) than among multiparas without prior cesarean deliveries (17.3%, 95% CI 16.4%-18.2%; eight studies, n=7903), and among women with private health insurance (44.3%, 95% CI 43.0%-45.6%; nine studies, n=6048) than among those who depended on the public healthcare system (22.7%, 95% CI 22.2%-23.3%; 20 studies, n=24314). Overall, most lay persons in Brazil did not prefer to deliver by cesarean.