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

Published:December 19, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100839

      Abstract

      Objective

      The aim of this study is to review obstetric providers’ personal preferences for cesarean delivery on maternal request (CDMR) in uncomplicated pregnancies.

      Data sources

      Searches were performed in Ovid-Medline, Cochrane, Scopus, CINAHL with terms related to “cesarean,” “elective,” “scheduled,” “maternal request,” “physician,” “obstetrician,” “gynecologist,” “midwife,” “specialist,” and “trainee.” There were no limitations 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 CDMR, if they were written in or translated into English, and if they did not meet any exclusion criteria.

      Study appraisal and synthesis methods

      The primary outcome was the percentage of providers preferring CDMR in a hypothetical uncomplicated nulliparous term singleton vertex (NTSV) pregnancy. Secondary outcomes included the percentage of providers preferring CDMR for a close family member in a NTSV pregnancy as well as the percentage of providers having a personal history of CDMR.

      Results

      34 articles were included in the review. The studies were performed across a range of time and geographical locations. The main providers studied were obstetrician-gynecologists (ob-gyns) and midwives. In the hypothetical scenario asking their personal delivery preference for a NTSV pregnancy, the overall preference for CDMR among all obstetric providers was 13.5% (966/7154), specifically 14.3% (894/6250) of ob-gyns 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 NTSV 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 CDMR was overall 20.9% (486/2324), specifically 25.2% (338/1339) of ob-gyns, and 2% (7/347) of midwives.

      Conclusions

      14.3% of ob-gyns would prefer CDMR for themselves in a hypothetical NTSV pregnancy, and this percentage has increased over the last 20 years. However, 25.2% of ob-gyns have had CDMR themselves, and 67% would recommend it for a close family member. Instead, ≤2% of midwives have had or would recommend CDMR.

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