Non-clinical interventions for reducing unnecessary caesarean section

Abstract

Background Caesarean 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. Objectives To evaluate the e ectiveness and safety of non-clinical interventions intended to reduce unnecessary caesarean section. Search methods We 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. Selection criteria Randomised trials, non-randomised trials, controlled before-a er studies, interrupted time series studies and repeated measures studies were eligible for inclusion. The primary outcome measures were: caesarean section, spontaneous vaginal birth and instrumental birth. Non-clinical interventions for reducing unnecessary caesarean section (Review)

Interventions to reduce unnecessary caesarean sections in healthy women and babies

“…This third paper in this Series on optimising CS rates is thus focused on interventions to reduce unnecessary CS, which we define as being performed in the absence of medical (including psychological) indications. [10][11][12] We begin with an overview of the drivers behind increasing CS rates. We then examine the nature and effects of both clinical and non-clinical (behavioural, educational, psychosocial) interventions that have been tested in studies specifically designed to safely reduce CS births.…”

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

“…One of the main referred difficulties was the lack of a classification tool that would be feasible to be used internationally, to allow audit feedback and setting an optimal CS rate over countries. To address this gap, in 2001, Robson et al proposed an overall classification method that facilitates an understanding of the rate of CS in a center and makes it possible to identify key subpopulation groups, all in order to inform measures aimed at preventing unnecessary procedures [10][11][12].The WHO has proposed the use of the Robson ten-group classification system (RTGCS) as the global standard, as this classification method allows for the analysis of changing trends over time, makes it possible to compare differences between centers and shed light on how changes in clinical practice can optimize caesarean rates, thus ensuring excellence in maternal and perinatal care [13]. The more in-depth analysis offered by this method allows us to examine issues such as which groups of women and which obstetric populations are most likely to undergo caesarean sections, information that can point us toward the kinds of interventions that might help reduce the rates of caesarean sections, when and where such reductions are desirable [14].The present study aimed to conduct an analysis of births using the RTGCS in La Ribera University Hospital over nine years and to assess the levels and trends of CS births.…”

“…One of the main referred difficulties was the lack of a classification tool that would be feasible to be used internationally, to allow audit feedback and setting an optimal CS rate over countries. To address this gap, in 2001, Robson et al proposed an overall classification method that facilitates an understanding of the rate of CS in a center and makes it possible to identify key subpopulation groups, all in order to inform measures aimed at preventing unnecessary procedures [10][11][12].…”

A cluster-randomized field trial to reduce cesarean section rates with a multifaceted intervention in Shanghai, China

“…Numerous attempts have been made to reduce the CS rate around the world [27,28,34,[36][37][38]. Unfortunately, the impact of a single intervention approach has been inconsistent and mostly limited [39]. Chaillet et al used multifaceted interventions, including audits of indications for CS, provision of feedback to health professionals, and implementation of best practices, and reported a statistically significant but small reduction in the CS rate (adjusted risk difference = − 1.8%; 95% CI − 3.8%, − 0.2%) [34].…”