Childbearing plans' predictive value for birth outcomes: A systematic review to inform mode of delivery decisions.

Objective: Rising cesarean delivery (CD) rates significantly impact maternal health, underscoring the need for comprehensive counseling. This review examines the consistency of childbearing plans over time and their predictive value for childbirth events.

Data Sources: PubMed, EMBASE, Web of Science, and PsycINFO databases up to October 2023.

Study Eligibility Criteria: Studies assessing women's childbearing plans at baseline (T1) and following up with subsequent plans and/or outcomes (T2).

Study Appraisal And Synthesis Methods: Meta-analyses calculated risk ratios and standardized mean differences using random-effects models. Bias was assessed using the Newcastle-Ottawa Scale.

Results: Forty-four studies (n = 132,846 women) were included. Average desired family size at T1 was 2.63 (95 %CI: 2.03-3.23), remaining stable at follow-up (p = 0.135). While no significant change in plans was observed for women who initially wanted children, negative plans showed significant instability (pooled effect size: 0.18, 95 %CI: 0.03-0.33; p = 0.0162). Estimated rates of stable, decreasing, and increasing childbearing plans were 74 %, 12 %, 11 %, respectively. Positive plans strongly predicted childbirth (RR = 3.95, 95 % CI: 2.46, 6.35; p < 0.0001; I = 98 %). Follow-up childbirth rates for initially negative plans were 5 % (95 % CI: 0-44 %) for nulliparae, 13 % (95 % CI: 2-57 %) for primiparae, and 64 % (95 % CI: 61-68 %) formultiparae.

Conclusions: On average, women desire 2.63 children (95 % CI: 2.03-3.23). Childbearing plans are largely stable, but around 10 % of women with negative or uncertain plans later desired children. Positive plans nearly quadrupled childbirth likelihood. Negative plans were less predictive, particularly in multiparous women. Future research should explore age, socioeconomics, and cultural contexts, particularly for nulliparous women over 35 considering elective CD.