{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:26:13Z","timestamp":1791908773579,"version":"4.3.4"},"reference-count":87,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women\u2019s preferences for mode of birth and factors underlying preferences for CS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women\u2019s partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021.<\/jats:p>\n<jats:p>Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth <jats:italic>(High confidence)<\/jats:italic>, uncertainty regarding vaginal birth <jats:italic>(High confidence)<\/jats:italic>, and positive views or perceived advantages of CS <jats:italic>(High confidence)<\/jats:italic>.<\/jats:p>\n<jats:p>Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births <jats:italic>(High confidence)<\/jats:italic>. The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth <jats:italic>(High confidence)<\/jats:italic>.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A wide variety of factors underlie women\u2019s preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0251072","type":"journal-article","created":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T19:25:58Z","timestamp":1620242758000},"page":"e0251072","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":75,"title":["Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7424-5551","authenticated-orcid":true,"given":"Mercedes","family":"Colomar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Newton","family":"Opiyo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Kingdon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soledad","family":"Nion","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan A.","family":"Bohren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Pilar","family":"Betran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,5]]},"reference":[{"issue":"5","key":"pone.0251072.ref001","doi-asserted-by":"crossref","first-page":"e260","DOI":"10.1016\/S2214-109X(15)70094-X","article-title":"Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys","volume":"3","author":"JP Vogel","year":"2015","journal-title":"Lancet Glob Heal"},{"issue":"2","key":"pone.0251072.ref002","doi-asserted-by":"crossref","first-page":"e0148343","DOI":"10.1371\/journal.pone.0148343","article-title":"The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990\u20132014.","volume":"11","author":"AP Betran","year":"2016","journal-title":"PLoS One."},{"issue":"10155","key":"pone.0251072.ref003","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/S0140-6736(18)31928-7","article-title":"Global epidemiology of use of and disparities in caesarean sections","volume":"392","author":"T Boerma","year":"2018","journal-title":"Lancet (London, England)."},{"issue":"2","key":"pone.0251072.ref004","doi-asserted-by":"crossref","first-page":"e0148343","DOI":"10.1371\/journal.pone.0148343","article-title":"The increasing trend in caesarean section rates: Global, regional and national estimates: 1990\u20132014.","volume":"11","author":"AP Betr\u00e1n","year":"2016","journal-title":"PLoS One"},{"key":"pone.0251072.ref005","doi-asserted-by":"crossref","first-page":"k55","DOI":"10.1136\/bmj.k55","article-title":"Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries","volume":"360","author":"AA Boatin","year":"2018","journal-title":"BMJ"},{"issue":"10184","key":"pone.0251072.ref006","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1016\/S0140-6736(18)32386-9","article-title":"Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis","volume":"393","author":"S Sobhy","year":"2019","journal-title":"Lancet (London, England)."},{"key":"pone.0251072.ref007","first-page":"CD005528","article-title":"Non-clinical interventions for reducing unnecessary caesarean section.","volume":"9","author":"I Chen","year":"2018","journal-title":"Cochrane database Syst Rev."},{"issue":"10155","key":"pone.0251072.ref008","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/S0140-6736(18)31927-5","article-title":"Interventions to reduce unnecessary caesarean sections in healthy women and babies","volume":"392","author":"AP Betran","year":"2018","journal-title":"Lancet (London, England)."},{"issue":"2","key":"pone.0251072.ref009","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/birt.12319","article-title":"Why do women request an elective cesarean delivery for non-medical reasons? 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