China has witnessed a rapid increase of cesarean section (CS) rates in recent years. Several non-clinical factors have been cited as contributing to this trend including maternal request and perceived convenience. We aimed to assess preferences for mode of delivery and reasons for preferences for CS in China to inform the development of future interventions to mitigate unnecessary CSs, which are those performed in the absence of medical indications. We conducted a mixed-methods systematic review and included longitudinal, cross-sectional, and qualitative studies in mainland China, Hong Kong, and Taiwan that investigated preferences for mode of delivery among women and family members and health professionals, and the reasons underlying such preferences. We searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, and one Chinese database (CNKI) using a combination of the key terms ‘caesarean section’, ‘preference’, ‘choice’, ‘knowledge’, ‘attitude’, ‘culture’, ‘non-clinical factors’, and ‘health professionals-patient relations’ between 1990 and 2018 without language restriction. Meta-analysis of quantitative studies and meta-synthesis of qualitative studies were applied. We included 66 studies in this analysis: 47 quantitative and 19 qualitative. For the index pregnancy, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95% CI 12%–17%) and 21% in late pregnancy (95% CI 15%–26%). In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95% CI 14%–20%), 22% in late pregnancy (95% CI 18%–25%), and 30% postpartum (95% CI 19%–40%). Women’s preferences for CS were found to rise as pregnancy progressed (preference change across longitudinal studies: mean difference 7%, 95% CI 1%–13%). One longitudinal study reported that the preference for CS among women’s partners increased from 8% in late pregnancy to 17% in the immediate postpartum period. In addition, 18 quantitative studies revealed that some pregnant women, ranging from 4% to 34%, did not have a straightforward preference for a mode of delivery, even in late pregnancy. The qualitative meta-synthesis found that women’s perceptions of CS as preferable were based on prioritising the baby’s and woman’s health and appeared to intensify through interactions with the health system. Women valued the convenience of bypassing labour because of fear of pain, antagonistic relations with providers, and beliefs of deteriorating quality of care during labour and vaginal birth, fostering the feeling that CS was the safest option. Health professionals’ preference for CS was influenced by financial drivers and malpractice fears. This review has some limitations, including high heterogeneity (despite subgroup and sensitivity analysis) in the quantitative analysis, and the potential for over-reporting of women’s preferences for CS in the qualitative synthesis (due to some included studies only including women who requested CS). Despite a minority of women expressing a preference for CS, individual, health system, and socio-cultural factors converge, contributing to a high CS rate in mainland China, Hong Kong, and Taiwan. In order to reduce unnecessary CSs, interventions need to address all these non-clinical factors and concerns. Prospero CRD42016036596.

Mastitis can be caused by ineffective positioning of the baby at the breast or restricted feeding. Infective mastitis is commonly caused by Staphylococcus aureus. The prevalence of mastitis in breastfeeding women may reach 33%. Effective milk removal, pain medication and antibiotic therapy have been the mainstays of treatment. This review aims to examine the effectiveness of antibiotic therapies in relieving symptoms for breastfeeding women with mastitis with or without laboratory investigation. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012), contacted investigators and other content experts known to us for unpublished trials and scanned the reference lists of retrieved articles. We selected randomised controlled trials (RCTs) and quasi‐RCTs comparing the effectiveness of various types of antibiotic therapies or antibiotic therapy versus alternative therapies for the treatment of mastitis. Two review authors independently assessed trial quality and extracted data. When in dispute, we consulted a third author. Two trials met the inclusion criteria. One small trial (n = 25) compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation. Another, older study compared breast emptying alone as 'supportive therapy' versus antibiotic therapy plus supportive therapy, and no therapy. The findings of the latter study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic. There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis. There is an urgent need to conduct high‐quality, double‐blinded RCTs to determine whether antibiotics should be used in this common postpartum condition. Antibióticos para mastite em lactantes A mastite pode ser causada por erros de posicionamento do bebê no seio materno ou amamentação restrita. A mastite infecciosa é geralmente causada pelo Staphylococcus aureus. Até 33 % das lactantes podem ter mastite. O tratamento habitual da mastite se baseia no esvaziamento do leite, analgésicos e antibióticos. O objetivo desta revisão foi avaliar a efetividade da antibioticoterapia no alívio dos sintomas de lactantes com mastite, com ou sem confirmação laboratorial do diagnóstico. Fizemos buscas na base de dados eletrônica no Cochrane Pregnancy and Childbirth Group Trials Register (em 30 de Setembro de 2012). Entramos em contato com pesquisadores e outros especialistas da área, buscando identificar estudos não publicados. A busca foi complementada pela análise das listas de referências bibliográficas dos artigos encontrados. Foram incluídos nesta revisão apenas ensaios clínicos controlados e randomizados (ECR) ou quasi ‐randomizados que compararam a efetividade de diversos esquemas de antibioticoterapia para o tratamento da mastite ou que compararam antibioticoterapia versus outros tipos de tratamento. Dois revisores avaliaram de forma independente a qualidade dos estudos e extraíram os dados. Um terceiro revisor foi consultado em caso de discordância entre os dois revisores. Dois estudos preencheram os critérios de inclusão. Um estudo com pequena casuística (n = 25) comparou Amoxacilina com Cefradina e não encontrou diferença significante entre esses dois antibióticos para o alívio dos sintomas ou na formação de abscessos. Outro estudo mais antigo, comparou o uso exclusivo do esvaziamento mamário versus antibioticoterapia mais esvaziamento, versus nenhum tratamento. Segundo esse estudo, a duração dos sintomas foi menor nas mulheres que receberam antibióticos; porém esse estudo teve falhas no seu desenho. As evidências são insuficientes para avaliar a efetividade da antibioticoterapia no tratamento da mastite puerperal. São necessários mais ensaios clínicos randomizados duplo‐cego e de boa qualidade antes que possam ser feitas recomendações quanto à prescrição, ou não, de antibióticos para o tratamento da mastite puerperal.