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Caesarean section vs vaginal birth: a narrative review of decision making and postnatal outcomes

02 October 2024
Volume 32 · Issue 10

Abstract

Background/Aims

Few studies have mapped decision-making factors behind mode of birth to postpartum outcomes. This review's aim was to compare factors that drive women's decision making on mode of birth and postnatal outcomes.

Methods

This narrative literature review of Google Scholar, PubMed, Medline and Wiley Online Library explored studies published from 2000 onwards that compared caesarean section and vaginal birth in relation to decision-making factors and postnatal quality of life. Extracted data were analysed thematically.

Results

A total of 10 articles were included. Most women favoured vaginal birth, associating it with satisfaction, fear of surgery and cultural norms. Caesarean sections were favoured because of a fear of pain, previous caesarean section experience and the perception that it was easier. There were poorer physical and mental postpartum quality of life outcomes for caesarean sections and assisted vaginal birth, even after 10 years.

Conclusions

Healthcare professionals require more exposure to supporting women to decide on mode of birth. Routine checks for new mothers require a holistic, person-centred approach as opposed to generalised care.

Implications for practice

Healthcare workers can and should make every contact with intending and present mothers count. Open conversations about childbirth need to be had, even outside of women's health spaces, with appropriate referrals and signposting to best available evidence for informed decisions to be made regarding mode of childbirth and expected outcomes.

Caesarean section rates have steadily increased, with global rates of 21.1% almost doubling since 2000 (Zewude et al, 2022). World Health Organization (WHO, 2021) records show that caesarean section rates grew from 7% in 1990 to 21% in 2021. By 2030, it is predicted that one-third of all births will likely be by caesarean section (WHO, 2021). This escalation is associated with an increase specifically in women choosing to have a caesarean section, as over 40% of caesarean sections are elective (Evans et al, 2022). This indicates a need to understand the driving factors and perceived benefits behind decision making in relation to mode of birth (Miller et al, 2016). It has been suggested that caesarean section may be seen as an easier option, although there is limited evidence to support this (Loke et al, 2015). Tuschy et al (2018) suggested that it was the result of advancements in medical procedures and equipment, as well as guidelines supporting women's autonomy in decision making (National Institute for Health and Care Excellence, 2019).

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