Systematic review and meta‐analysis of studies on delivery preferences in Brazil

BACKGROUND: Cesarean delivery rates in Brazil are among the highest in the world. User preference is often mentioned as an important factor driving this. OBJECTIVES: To identify, appraise, and synthesize the results of studies into delivery preferences in Brazil. SEARCH STRATEGY: MEDLINE, LILACS, and PsycINFO databases were searched, without language restrictions, using "delivery" and "preference" from inception to November 4, 2017. SELECTION CRITERIA: Cross-sectional or cohort studies with quantitative data on delivery preferences of lay persons in Brazil. DATA COLLECTION AND ANALYSIS: Two reviewers performed study selection, quality assessment, and data extraction. A meta-analysis of proportions with a preference for cesarean delivery was performed, including subgroups analyses. MAIN RESULTS: There were 28 studies with 31 071 participants included. The overall prevalence of preference for cesarean delivery was 27.2% (95% confidence interval [CI] 26.7%-27.7%; 28 studies, n=31 071). Cesarean delivery preference was higher among multiparas with previous cesarean deliveries (58.0%, 95% CI 56.6%-59.3%; nine studies, n=5542) than among multiparas without prior cesarean deliveries (17.3%, 95% CI 16.4%-18.2%; eight studies, n=7903), and among women with private health insurance (44.3%, 95% CI 43.0%-45.6%; nine studies, n=6048) than among those who depended on the public healthcare system (22.7%, 95% CI 22.2%-23.3%; 20 studies, n=24 314). CONCLUSIONS: Overall, most lay persons in Brazil did not prefer to deliver by cesarean.