Women's request for a cesarean section: a critique of the literature.

BACKGROUND: The consistently high cesarean section rate in most developed Western countries has been attributed in part to maternal request. This controversial view demands critical analysis. This paper provides a critique of published research relating to women's request for cesarean delivery.
METHOD: A search of the major databases was undertaken using the search term "cesarean section" with "maternal request," "decision-making," "patient-participation," "decision-making-patient," "patient-satisfaction," "patient-preference," and "maternal-choice." Ten research articles examining women's preferred mode of birth were retrieved, nine of which focused on women's preference for cesarean delivery.
RESULTS: The methodology of some studies may result in overreporting women's request for a cesarean delivery. The role of the woman's caregiver in the generation, collection, and entry of data, and the occurrence of post hoc rationalization, recall bias, and women's tendency to be less critical of their care immediately after birth are possible areas of concern. Due consideration is rarely given to the influence of obstetric risk for women who may be requesting a cesarean section or to the information women used in making their decision. Women's perceptions of their involvement in decision-making regarding cesarean section are used to draw conclusions regarding women's request.
CONCLUSIONS: Few women request a cesarean section in the absence of current or previous obstetric complications. The focus on women's request for cesarean section may divert attention away from physician-led influences on the continuing high cesarean section rates.