Why do women request an elective cesarean delivery for non-medical reasons? A systematic review of the qualitative literature

Birth. 2018 Jun;45(2):109-119. doi: 10.1111/birt.12319. Epub 2017 Nov 6.


Background: Cesarean rates have increased significantly over the past decade. The reasons for this are both complex and context specific, and have significant consequences for health resources. The aim of this systematic review was to assess published, peer-reviewed, and gray qualitative literature on the reasons behind cesarean delivery on maternal request (CDMR).

Methods: A systematic search of MEDLINE, EMBASE, CINAHL, LILACS, and PsycINFO databases was performed for all relevant articles published between January 2006 and June 2016. Reference lists of all included studies were also searched in addition to select web-based sources. Studies were included if they qualitatively evaluated women's preferences for CDMR, with no geographic restriction. Findings from the studies were narratively and thematically synthesized.

Results: Sixteen studies were included in this review. Three themes were identified as to why women choose CDMR, which were: social norms, emotional experiences, and personal experiences. A woman's decision was often shaped by various influences including family, friends, and the media. In addition, previous experience of childbirth and interactions with health care professionals contributed to a strong preference for CDMR. CDMR provided women with a sense of control over the birth and diminished feelings of fear.

Conclusions: The reasons behind CDMR are multifactorial and complex. Situation-specific cultural factors, fear of pain during childbirth, previous experience, and interactions with health care professionals are likely to have led to the increase in CDMR. Multifaceted, context-specific approaches are required if there is to be a reduction in CDMR rates.

Keywords: cesarean; cesarean delivery; cesarean delivery on maternal request.

Publication types

  • Systematic Review

MeSH terms

  • Cesarean Section / psychology*
  • Decision Making
  • Elective Surgical Procedures / psychology*
  • Female
  • Humans
  • Patient Preference / psychology*
  • Pregnancy
  • Professional-Patient Relations