• Jenny Gamble, Debra K Creedy, Chris McCourt, Jane Weaver, and Sarah Beake.
• Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Australia.
• Birth. 2007 Dec 1;34(4):331-40.

BackgroundThe influence of women's birth preferences on the rising cesarean section rates is uncertain and possibly changing. This review of publications relating to women's request for cesarean delivery explores assumptions related to the social, cultural, and political-economic contexts of maternity care and decision making.MethodA search of major databases was undertaken using the following terms: "c(a)esarean section" with "maternal request,"decision-making,"patient participation,"decision-making-patient,"patient satisfaction,"patient preference,"maternal choice,"on demand," and "consumer demand." Seventeen papers examining women's preferred type of birth were retrieved.ResultsNo studies systematically examined information provided to women by health professionals to inform their decision. Some studies did not adequately acknowledge the influence of obstetric and psychological factors in relation to women's request for a cesarean section. Other potential influences were poorly addressed, including whether or not the doctor advised a vaginal birth, women's access to midwifery care in pregnancy, information provision, quality of care, and cultural issues.DiscussionThe psychosocial context of obstetric care reveals a power imbalance in favor of physicians. Research into decision making about cesarean section that does not account for the way care is offered, observe interactions between women and practitioners, and analyze the context of care should be interpreted with caution.

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