Continuous intrapartum support to reduce primary cesarean in Mexico

Abstract

Background Cesarean deliveries are effective in saving maternal and infant lives, but only when they are necessary for medical reasons. In Mexico, the average cesarean delivery rate in 2015 was reported at 45%, the high incidence of cesarean deliveries is considered a problem of public health in the country, our purpose was to reduce the cesarean delivery rate for primary cesarean, in nulliparous women, term, singleton, vertex presentation and under 40 years through continuous intrapartum support provided by a professional nurse. Methods This was a historical control study, in a health institution in Mexico, in the period de July-December 2018. The control group received the usual obstetric care, without continuous intrapartum support. The study group received the usual obstetric care plus continuous intrapartum support, it was obtained the cesarean delivery rate, estimating the risk ratio, the absolute risk reduction and odds ratio, in addition, a binomial logistic regression model was carried out and was adjusted with possible covariates. Results In the study group the cesarean delivery rate was 1.7% (1 of 60) significantly lower than in the control group (29.1% (16 of 55) [X 2 = 17.13, df = 1, N = 115, p < .001], with a risk ratio of 0.06 (95% CI: 0.01 to 0.42), the absolute risk reduction was 27.4%, (95% CI: 15% - 40%), also the hours of labor were significantly lower (p < 0.001) in the study group (median = 6.7 hours, 95% CI: 6.0-8.1), than in the control group (median = 13.4 hours, 95% CI: 10.7 - 16.1) and no significant covariates were found. Keywords: Cesarean delivery rate, Continuous intrapartum support, labor