Non-clinical interventions for reducing unnecessary caesarean section

Abstract

BackgroundCaesarean section rates are increasing globally. The factors contributing to this increase are complex, and identifying interventions to address them is challenging. Non-clinical interventions are applied independently of a clinical encounter between a health provider and a patient. Such interventions may target women, health professionals or organisations. They address the determinants of caesarean births and could have a role in reducing unnecessary caesarean sections. This review was first published in 2011. This review update will inform a new WHO guideline, and the scope of the update was informed by WHO's Guideline Development Group for this guideline. ObjectivesTo evaluate the effectiveness and safety of non-clinical interventions intended to reduce unnecessary caesarean section. Search methodsWe searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers in March 2018. We also searched websites of relevant organisations and reference lists of related reviews. 1 Non-clinical interventions for reducing unnecessary caesarean section (Review)

Is place of birth associated with mode of birth? The effect of hospital on caesarean section rates in a public metropolitan health service

“…The lower rate of operative vaginal deliveries could provide one explanation for the higher caesarean sections rates at Casey. Khunpradit et al 5 in their systematic review of interventions for reducing unnecessary caesarean sections recommend that the '…implementation of guidelines with mandatory second opinion can lead to a small reduction in caesarean section rates, predominately in intrapartum sections' (p. 2). However, the implementation of mandatory second opinion for caesarean section has financial, logistical and resource implications, which may be difficult to overcome.…”

“…In particular, there is genuine concern about rising caesarean section rates, which reached 30.6% in Victoria in 2008, 2 a doubling in 20 years 3 without any evidence of improved perinatal outcomes, and discussion about how to prevent further rises using evidence-based approaches. 4,5 Research into rising caesarean section rates has focussed extensively on the clinical indications for the observed rises but has also attempted to understand why variations exist between countries, geographical areas, hospitals and models of care. The effects of place of birth on birth outcomes have also been examined internationally.…”

Existe associação entre os desconfortos no puerpério imediato e a via de parto? Um estudo observacional

“…Esse achado está de acordo com a literatura, a qual mostra que, apesar da recomendação da OMS, as taxas de cesáreas vêm aumentando em muitos países, dentre eles o Brasil 9,10 . A crescente demanda por cesárea parece estar baseada na crença de que a qualidade da atenção obstétrica encontra-se intimamente associada à tecnologia no trabalho de parto e no nascimento 11 .…”

Cesarean delivery

“…There are limited data of nonclinical interventions aimed at decreasing the unnecessary CD rate (6). Implementation of guidelines with mandatory second opinion can lead to a small reduction in CD rates, predominately in intrapartum CDs (7).…”

“…14). Nurse-led relaxation classes and birth preparation classes may reduce CD rates in low-risk pregnancies (6). There is insufficient evidence that prenatal education and support programs, computer-based patient decision aids, decision-aid booklets, and intensive group therapy are effective.…”