Reducing caesarean section rates – No easy task

Abstract

To identify the greatest potential for reducing overall caesarean delivery rates, we used longitudinally-linked data for women with consecutive births 2001-2009 to examine the likely impact of hypothetical risk-based scenarios. Among women with a first-birth, singleton, vertex-presenting fetus at term, increasing the vaginal birth rate following induction of labour by 20% potentially has greatest impact, with a 12.1% relative decrease in the overall caesarean rate. The potential relative decrease of other scenarios ranged from 0.8% to 6.4%.

Improving VBAC rates: the combined impact of two management strategies

“…40.4% of women in our study underwent a trial of labour with a VBAC success rate of 64.4%. These figures are close to rates achieved in the 1990s (46 and 61%, respectively), and it has been projected that achieving such rates could cause a relative reduction in the total caesarean rate by up to 5.9% . Whilst this appears promising, given our success rate of 64.4%, which is comparable to prior literature, the ‘Towards Normal Birth in NSW’ 2015 target of >60% seems nevertheless unachievable.…”

Avoiding the first cesarean section–results of structured organizational and cultural changes

“…This corresponded to Robson group 1, based on the Ten‐Group Classification System . The focus on Robson group 1 was due to the consequences of a first cesarean delivery on subsequent deliveries, and the higher risk of adverse outcomes in nulliparous compared with multiparous women . During the quality improvement project we found it clinically relevant to continuously follow the rate of interventions and obstetric outcome data not only for the target group, but also for all term nulliparous women and the total population of delivering women in order to secure the overall patient safety at the unit.…”

Thirty years of the World Health Organization's target caesarean section rate: time to move on

“…In Australia, less than 5% of all births are to teenaged women, and the rate of CS in this group was 15% or less until 2002; since then, the rate has averaged 17.4%, with no significant increase since 2005 ( P = 0.27) (Box 1). This is good news for teenaged mothers, because Australian women whose first birth is vaginal are overwhelmingly likely to have vaginal deliveries of all subsequent children 31 . Women who have a primary caesarean delivery, however, are most likely to have all subsequent children by repeat caesarean delivery 32 …”