Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression

Background: Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. Objectives: To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. Search strategy: PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. Selection criteria: Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. Data collection and analysis: Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. Main results: We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. Conclusions: An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. Tweetable abstract: Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country